Provider Demographics
NPI:1831205327
Name:ALFALAHI, ETIHAD SHAKIR (MD)
Entity type:Individual
Prefix:DR
First Name:ETIHAD
Middle Name:SHAKIR
Last Name:ALFALAHI
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 1:763 S NEW BALLAS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8711
Mailing Address - Country:US
Mailing Address - Phone:314-983-0606
Mailing Address - Fax:314-983-0608
Practice Address - Street 1:763 S NEW BALLAS RD STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8711
Practice Address - Country:US
Practice Address - Phone:314-983-0606
Practice Address - Fax:314-983-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD101423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286120OtherHEALTHLINK
MO1210150OtherUNITED HEALTHCARE
MOG10654OtherMERCY HEALTH PLAN
MO5013620OtherAETNA
MO214028OtherGROUP HEALTH PLAN
MO114721OtherBLUE CROSS BLUE SHIELD
MOG10654Medicare UPIN