Provider Demographics
NPI:1255543047
Name:MALAZ SAFI, M.D., P.C.
Entity type:Organization
Organization Name:MALAZ SAFI, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-543-2850
Mailing Address - Street 1:8790 WATSON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5140
Mailing Address - Country:US
Mailing Address - Phone:314-543-2850
Mailing Address - Fax:314-543-2851
Practice Address - Street 1:8790 WATSON RD STE 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5140
Practice Address - Country:US
Practice Address - Phone:314-543-2850
Practice Address - Fax:314-543-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-031037207W00000X
MOR9B71207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500046701Medicaid
IL296746824Medicaid
MODD3116OtherRAILROAD MEDICARE
IL0269280001OtherNATIONAL GOVERNMENT SERVI
ILDC5331OtherRAILROAD MEDICARE
MOA10241Medicare UPIN
IL0269280001OtherNATIONAL GOVERNMENT SERVI
MO0269280001Medicare NSC
MO990001192Medicare PIN