Provider Demographics
NPI:1720055452
Name:INFECTIOUS DISEASES PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AAMINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-821-0900
Mailing Address - Street 1:10004 KENNERLY ROAD
Mailing Address - Street 2:#171B
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-821-0900
Mailing Address - Fax:800-556-8932
Practice Address - Street 1:10004 KENNERLY ROAD
Practice Address - Street 2:#171B
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-821-0900
Practice Address - Fax:800-556-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506049501Medicaid
MO6016660001Medicare NSC
MO506049501Medicaid