Provider Demographics
NPI:1245401702
Name:ABDUL KHALIQ MUHAMMUD MD LLC
Entity Type:Organization
Organization Name:ABDUL KHALIQ MUHAMMUD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:KHALIQ
Authorized Official - Last Name:MUHAMMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-2700
Mailing Address - Street 1:2870 NETHERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4649
Mailing Address - Country:US
Mailing Address - Phone:314-355-2700
Mailing Address - Fax:314-355-2720
Practice Address - Street 1:2870 NETHERTON DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4649
Practice Address - Country:US
Practice Address - Phone:314-355-2700
Practice Address - Fax:314-355-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty