Provider Demographics
NPI:1497827968
Name:JUNAID, KULSOOM FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:KULSOOM
Middle Name:FATIMA
Last Name:JUNAID
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 1:11 SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8408
Mailing Address - Country:US
Mailing Address - Phone:314-922-2662
Mailing Address - Fax:
Practice Address - Street 1:1400 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2408
Practice Address - Country:US
Practice Address - Phone:314-776-7990
Practice Address - Fax:314-772-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010171512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205741903Medicaid
MO205741903Medicaid
MO113050174Medicare ID - Type Unspecified