Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036149154 | IL |
Y | 111NI0900X | Internist | 036149154 | IL |
N | 207RC0200X | Critical Care Medicine | 246095 | MA |
N | 207RP1001X | Pulmonary Disease | 036149154 | IL |
N | 207RP1001X | Pulmonary Disease | 2018003079 | MO |
N | 207RP1001X | Pulmonary Disease | 246095 | MA |
NPI | 1013178235 |
---|---|
Provider Name | Dr. Ashfaq Ullah |
First Address | Saint Louis, MO 63195-5534 |
Second Address | Bridgeton, MO 63044-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 15/07/2021 |