Provider Demographics
NPI:1518337815
Name:GASTROENTEROLOGY MEDICAL CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY MEDICAL CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KARADAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-462-2359
Mailing Address - Street 1:PO BOX 7686
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-7686
Mailing Address - Country:US
Mailing Address - Phone:618-462-2359
Mailing Address - Fax:618-462-2398
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-462-2359
Practice Address - Fax:618-462-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205245Medicare PIN
MO000092763Medicare PIN
MO1619963063Medicaid