Provider Demographics
NPI:1326353855
Name:AL ISMAIL, GHADAH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHADAH
Middle Name:
Last Name:AL ISMAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8124
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-747-2460
Practice Address - Street 1:5201 MID AMERICA PLZ STE 2300
Practice Address - Street 2:STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-286-1900
Practice Address - Fax:314-286-1908
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013486207RG0100X
MO2013021393207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid