Provider Demographics
NPI:1376599480
Name:ELDIN, ALI SHERIF (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SHERIF
Last Name:ELDIN
Suffix:
Gender:M
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:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0125
Mailing Address - Country:US
Mailing Address - Phone:888-731-1036
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:ONE MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:618-463-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR9G17207L00000X
IL036077965207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00317566OtherRR MEDICARE
MO202401121Medicaid
MO203133OtherBCBS MO (GROUP #)
MO203133OtherBCBS MO (GROUP #)
P00317566OtherRR MEDICARE
MO202401121Medicaid
MO002014814Medicare PIN
$$$$$$$$$OtherHEALTHNET/TRICARE
IL$$$$$$$$$Medicaid