Provider Demographics
NPI:1952555005
Name:MANZOOR TARIQ, INC.
Entity Type:Organization
Organization Name:MANZOOR TARIQ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MANZOOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-931-7111
Mailing Address - Street 1:1071 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4103
Mailing Address - Country:US
Mailing Address - Phone:636-931-7111
Mailing Address - Fax:
Practice Address - Street 1:1071 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4103
Practice Address - Country:US
Practice Address - Phone:636-931-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133876363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203400247Medicaid
MOE24297Medicare UPIN