Basic Information
| Provider Information | |||||||||
| NPI: | 1265434815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALAL | ||||||||
| FirstName: | RASHID | ||||||||
| MiddleName: | AHMED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7 BEAVER CREEK CT | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633035497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182399500 | ||||||||
| FaxNumber: | 6182399555 | ||||||||
| Practice Location | |||||||||
| Address1: | 4550 MEMORIAL DR | ||||||||
| Address2: | MEDICAL BLDG 1 SUITE 360 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182399500 | ||||||||
| FaxNumber: | 6182399555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD103192 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 036090043 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 3100008 NEPH | 01 | UNITED HEALTHCARE | OTHER | 8226186 | 01 | IL | BCBS | OTHER | 2369786 | 01 | AETNA PRUDENTIAL | OTHER | 816M2 | 01 | MO | BCBS ALLIANCE | OTHER | 203771902 | 05 | MO | MEDICAID | 286639 | 01 | HEALTHLINK PPO HMO WC | OTHER | 38137 | 01 | GHP SENSICARE ACCESS, CMR | OTHER | 110184061 | 01 | RR MEDICARE | OTHER | 110483 | 01 | BCBS CHOICE | OTHER | 036090043 | 05 | IL | MEDICAID |