Provider Demographics
NPI:1619216801
Name:MOHIDEEN A JAMALUDDIN M D INC
Entity Type:Organization
Organization Name:MOHIDEEN A JAMALUDDIN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHIDEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMALUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-0200
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0189
Mailing Address - Country:US
Mailing Address - Phone:636-937-0200
Mailing Address - Fax:636-937-9693
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1800
Practice Address - Country:US
Practice Address - Phone:636-937-0200
Practice Address - Fax:636-937-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9519207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty