Provider Demographics
NPI:1164531877
Name:RAZZAQ, ASIM (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR STE 375
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-567-6071
Mailing Address - Fax:314-434-1277
Practice Address - Street 1:112 PIPER HILL DR STE 12
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:369-996-9202
Practice Address - Fax:314-743-1338
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036094514208800000X
MO118587208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37572Medicare UPIN
MO011010816Medicare PIN