Provider Demographics
NPI:1982807335
Name:BHUTTO, SHAFIA M (MD)
Entity Type:Individual
Prefix:
First Name:SHAFIA
Middle Name:M
Last Name:BHUTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:STE 4005B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-567-5016
Mailing Address - Fax:314-567-1846
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:STE 4005B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-567-5016
Practice Address - Fax:314-567-1846
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007008450207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1982807335Medicaid
MOP01070254OtherRAILROAD MEDICARE
MOP01070254OtherRAILROAD MEDICARE