Provider Demographics
NPI:1043262009
Name:ABDUL KHADER, SYED A (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:A
Last Name:ABDUL KHADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12255 DE PAUL DR STE 120
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2513
Practice Address - Country:US
Practice Address - Phone:314-291-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005127208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO250013818OtherRAILROAD MEDICARE
MO166144OtherBLUE CROSS BLUE SHIELD
MO508368OtherHEALTHLINK
MO2300284OtherUNITED HEALTHCARE
MO128385OtherGROUP HEALTH PLAN
MO7666443OtherAETNA
MO128385OtherGROUP HEALTH PLAN
MOH69872Medicare UPIN