Provider Demographics
NPI:1962467001
Name:JALAL, ZULEKHA SAFIYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ZULEKHA
Middle Name:SAFIYA
Last Name:JALAL
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0368
Mailing Address - Country:US
Mailing Address - Phone:573-624-3165
Mailing Address - Fax:573-624-3157
Practice Address - Street 1:1300 N ONE MILE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1042
Practice Address - Country:US
Practice Address - Phone:573-624-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112442208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111332OtherBCBS
MO341428OtherHEALTHLINK
MO208948901Medicaid
MO208948901Medicaid
MO341428OtherHEALTHLINK