Basic Information
| Provider Information | |||||||||
| NPI: | 1497000194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANWAR | ||||||||
| FirstName: | SIDDIQ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 THE BOULEVARD SAINT LOUIS | ||||||||
| Address2: | # 201 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144754754 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 660 S EUCLID AVE # 8129 | ||||||||
| Address2: | RENAL FELLOWSHIP PROGRAM | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143627211 | ||||||||
| FaxNumber: | 3147473743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 2012021715 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.