Provider Demographics
NPI:1932285475
Name:ALBANNA, FAISAL J (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:J
Last Name:ALBANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-849-9090
Mailing Address - Fax:314-849-4165
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3854
Practice Address - Country:US
Practice Address - Phone:314-849-9090
Practice Address - Fax:314-849-4165
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7G64207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO03038OtherBLUE CROSS BLUE SHIELD
MO4004037OtherAETNA
MO100068OtherHEALTHLINK
MO43552OtherGHP
MOA13592Medicare UPIN