Basic Information
| Provider Information | |||||||||
| NPI: | 1376599480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELDIN | ||||||||
| FirstName: | ALI | ||||||||
| MiddleName: | SHERIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1125 | ||||||||
| Address2: | |||||||||
| City: | MARYLAND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630430125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887311036 | ||||||||
| FaxNumber: | 4238925838 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEMORIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 631366119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184637311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MDR9G17 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 036077965 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00317566 | 01 | RR MEDICARE | OTHER | 202401121 | 05 | MO | MEDICAID | BE1032286 | 01 | MO | DEA | OTHER | 203133 | 01 | MO | BCBS MO (GROUP #) | OTHER |