Provider Demographics
NPI:1518088772
Name:BASHIR, ANEELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANEELA
Middle Name:
Last Name:BASHIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANEELA
Other - Middle Name:BASHIR
Other - Last Name:QAYUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:176 LINDBERGH PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5926
Mailing Address - Country:US
Mailing Address - Phone:143-479-5557
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON BARRACKS DR BLDG 55
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-894-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510087Medicare PIN