Provider Demographics
NPI:1982860094
Name:TANOLI, TARIQ SARFRAZ KHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:SARFRAZ KHAN
Last Name:TANOLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 500 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3513
Mailing Address - Country:US
Mailing Address - Phone:314-878-6260
Mailing Address - Fax:314-878-8058
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 500 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3513
Practice Address - Country:US
Practice Address - Phone:314-878-6260
Practice Address - Fax:314-878-8058
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2016-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2008020161207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149920015Medicare PIN