Provider Demographics
NPI:1629028964
Name:GHANI, MOHAMMAD F (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:F
Last Name:GHANI
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 240106
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63024-0106
Mailing Address - Country:US
Mailing Address - Phone:314-644-5300
Mailing Address - Fax:314-644-5308
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-644-5300
Practice Address - Fax:314-644-5308
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4716207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200761310Medicaid
MOP00395464OtherRR MEDICARE
MOP00392848OtherRR MEDICARE
MO003014572Medicare PIN
MO200761310Medicaid
A11538Medicare UPIN
MOP00395464OtherRR MEDICARE