Provider Demographics
NPI:1679536403
Name:BAIG, MAIMUNA (MD)
Entity Type:Individual
Prefix:
First Name:MAIMUNA
Middle Name:
Last Name:BAIG
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 1:2 HARBOR BEND CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1478
Mailing Address - Country:US
Mailing Address - Phone:636-561-2220
Mailing Address - Fax:636-625-4723
Practice Address - Street 1:2 HARBOR BEND CT
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1478
Practice Address - Country:US
Practice Address - Phone:636-561-2220
Practice Address - Fax:636-625-4723
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36225208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100766OtherBCBS MO PAPER CLAIMS
MOBA202217311Medicaid
S04011OtherSSM HEALTHCARE
110141833OtherPALMETTO GBA/RAILROAD MCR
MO18031OtherBCBS MO ELECTRONIC
107274OtherHEALTHLINK
107274OtherHEALTHLINK
MO000008843Medicare ID - Type UnspecifiedMO MCR