Basic Information
Provider Information
NPI: 1639432032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHMAD
FirstName: MUNEEB
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 232 S WOODS MILL RD
Address2:  
City: CHESTERFIELD
State: MO
PostalCode: 630173406
CountryCode: US
TelephoneNumber: 3144341500
FaxNumber:  
Practice Location
Address1: 232 S WOODS MILL RD
Address2:  
City: CHESTERFIELD
State: MO
PostalCode: 630173406
CountryCode: US
TelephoneNumber: 3144341500
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2012
LastUpdateDate: 04/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X2018021468MOY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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