Provider Demographics
NPI:1093772923
Name:ISMAIL, MOHAMMAD KASHIF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:KASHIF
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-362-2357
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM GASTROENTEROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-362-2357
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022018368207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207493701Medicaid
TN3873009Medicaid
3873009Medicare ID - Type Unspecified