Provider Demographics
NPI:1003962820
Name:YOUNUS, SUMERA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMERA
Middle Name:
Last Name:YOUNUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUMERA
Other - Middle Name:
Other - Last Name:KHAYAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-5772
Mailing Address - Fax:314-996-7691
Practice Address - Street 1:3009 N BALLAS RD STE 387C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2324
Practice Address - Country:US
Practice Address - Phone:314-996-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004486208M00000X
MI4301082145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080D410020OtherBCBS
MI4967910Medicaid
MII68444Medicare UPIN
MIOM28430145Medicare ID - Type Unspecified