Basic Information
| Provider Information | |||||||||
| NPI: | 1972596757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAUSHAD | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | NAEEM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 COLLINS DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366381506 | ||||||||
| FaxNumber: | 6366381507 | ||||||||
| Practice Location | |||||||||
| Address1: | 2865 JAMES BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737761100 | ||||||||
| FaxNumber: | 5737761107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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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 | 207LP2900X | 2002024819 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 2002024819 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 794101 | 01 | MO | HEALTHLINK HMO | OTHER | 7475459 | 01 | MO | AETNA | OTHER | 1972596757 | 05 | MO | MEDICAID | 176806 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 567896 | 01 | MO | HEALTHLINK PPO | OTHER | 158238001 | 05 | AR | MEDICAID | 305205 | 01 | MO | GHP | OTHER | 00002259957 | 01 | MO | UHC | OTHER | P00094934 | 01 | MO | MCRR | OTHER |