Provider Demographics
NPI:1144419144
Name:ALAM, TARIQ JAWAID (MD, FAAN)
Entity Type:Individual
Prefix:MR
First Name:TARIQ
Middle Name:JAWAID
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 US HIGHWAY 61, SOUTH, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-933-8270
Mailing Address - Fax:636-933-1233
Practice Address - Street 1:1400 US HIGHWAY 61, SOUTH, SUITE 120
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-933-8270
Practice Address - Fax:636-933-1233
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI746082084N0400X
MO20120159512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology