Provider Demographics
NPI:1710177480
Name:AL BADR, WISAM HASSAN ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:WISAM
Middle Name:HASSAN ALI
Last Name:AL BADR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9625 CHANCELORSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3312
Mailing Address - Country:US
Mailing Address - Phone:314-577-8765
Mailing Address - Fax:314-771-0784
Practice Address - Street 1:3635 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8765
Practice Address - Fax:314-771-0784
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008384282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access