Provider Demographics
NPI:1225587272
Name:SYED SHAHID MUMTAZ MD
Entity Type:Organization
Organization Name:SYED SHAHID MUMTAZ MD
Other - Org Name:CHESTERFIELD VALLEY PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:SHAHID
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-519-7404
Mailing Address - Street 1:17269 WILD HORSE CREEK RD
Mailing Address - Street 2:#250
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1360
Mailing Address - Country:US
Mailing Address - Phone:636-519-7404
Mailing Address - Fax:636-537-0043
Practice Address - Street 1:17269 WILD HORSE CREEK RD
Practice Address - Street 2:#250
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1360
Practice Address - Country:US
Practice Address - Phone:636-519-7404
Practice Address - Fax:636-537-0043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERFIELD VALLEY PSYCHIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1144592084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty