Provider Demographics
NPI:1639811334
Name:BADR, BISMA (MD)
Entity type:Individual
Prefix:DR
First Name:BISMA
Middle Name:
Last Name:BADR
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:BISMA
Other - Middle Name:
Other - Last Name:BADR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:WUSM PEDS
Mailing Address - Street 2:1 CHILDRENS PL MSC 8116-0043-09
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-454-2341
Mailing Address - Fax:314-454-4345
Practice Address - Street 1:WUSM PEDS
Practice Address - Street 2:1 CHILDRENS PL MSC 8116-0043-09
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-454-2341
Practice Address - Fax:314-454-4345
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-04-29
Deactivation Date:2023-01-03
Deactivation Code:
Reactivation Date:2023-01-31
Provider Licenses
StateLicense IDTaxonomies
MO2025013410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics