Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD464248 | PA |
N | 111NI0900X | Internist | MD464248 | PA |
N | 207R00000X | Internist | MT207965 | PA |
N | 111NI0900X | Internist | MT207965 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 2019014567 | MO |
NPI | 1013392018 |
---|---|
Provider Name | Dr. Ali Raza Ghani |
First Address | St Louis, MO 63110 |
Second Address | St. Louis, MO 63310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 04/06/2019 |