Provider Demographics
NPI:1760477426
Name:IMDAD, RIFFAT Y (MD)
Entity Type:Individual
Prefix:DR
First Name:RIFFAT
Middle Name:Y
Last Name:IMDAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 LEMAY FERRY RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3900
Mailing Address - Country:US
Mailing Address - Phone:314-525-1887
Mailing Address - Fax:314-525-1868
Practice Address - Street 1:2900 LEMAY FERRY RD
Practice Address - Street 2:STE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-525-1887
Practice Address - Fax:314-525-1868
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160629207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205326508Medicaid
MO205326508Medicaid
MO205326508Medicaid