Provider Demographics
NPI:1235300286
Name:INTERNAL MEDICINE & GERIATRICS ASSOCIATES, INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & GERIATRICS ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIRA
Authorized Official - Middle Name:MIR
Authorized Official - Last Name:ASADULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-916-9091
Mailing Address - Street 1:1836 LACKLAND HILL PKWY
Mailing Address - Street 2:ATTN CREDENTIALING DEPARTMENT
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3572
Mailing Address - Country:US
Mailing Address - Phone:314-872-1308
Mailing Address - Fax:314-810-1399
Practice Address - Street 1:70 JUNGERMANN CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1622
Practice Address - Country:US
Practice Address - Phone:636-916-9091
Practice Address - Fax:636-447-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014820207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015639Medicare PIN