Provider Demographics
NPI:1386660603
Name:BILDIRICI, IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:
Last Name:BILDIRICI
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 8221
Mailing Address - Street 2:7425 FORSYTH
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-8221
Mailing Address - Country:US
Mailing Address - Phone:314-935-0770
Mailing Address - Fax:314-935-0575
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:SUITE 5A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-1336
Practice Address - Fax:314-747-1720
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021801207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
140061Medicare UPIN