Basic Information
| Provider Information | |||||||||
| NPI: | 1326353855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL ISMAIL | ||||||||
| FirstName: | GHADAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | C B 8124 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147472066 | ||||||||
| FaxNumber: | 3147472460 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 MID AMERICA PLZ STE 2300 | ||||||||
| Address2: | STE 2300 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631290002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142861900 | ||||||||
| FaxNumber: | 3142861908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2010 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2016013486 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | IL | MEDICAID |