Basic Information
| Provider Information | |||||||||
| NPI: | 1437363553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAWAF-HAJJI | ||||||||
| FirstName: | RANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SAWAF | ||||||||
| OtherFirstName: | RANDA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12255 DE PAUL DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142095100 | ||||||||
| FaxNumber: | 3142095152 | ||||||||
| Practice Location | |||||||||
| Address1: | 12255 DE PAUL DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142095100 | ||||||||
| FaxNumber: | 3142095152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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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 | 207R00000X | 2004033970 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.