Provider Demographics
NPI:1326258617
Name:QURESHI, SHAHAB
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:QURESHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 W PINE BLVD
Mailing Address - Street 2:#6H
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1431
Mailing Address - Country:US
Mailing Address - Phone:206-369-6015
Mailing Address - Fax:
Practice Address - Street 1:1100 S GRAND BLVD
Practice Address - Street 2:DEPT. OF INFECTIOUS DISEASES
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1015
Practice Address - Country:US
Practice Address - Phone:314-977-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine