| Gateway Hospitalist Pc | |
|
4455 Duncan Ave Saint Louis MO 63110-1111 | |
| (314) 658-3800 | |
| (636) 333-4510 |
| Full Name | Gateway Hospitalist Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4455 Duncan Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Mohammed Haque (OWNER) |
| Authorized Official Contact | 3147133665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Hospitalist Pc Po Box 1449 Maryland Heights MO 63043-0449 Ph: (314) 713-3665 | Gateway Hospitalist Pc 4455 Duncan Ave Saint Louis MO 63110-1111 Ph: (314) 658-3800 |
| NPI Number | 1225072671 |
|---|---|
| Provider Enumeration Date | 06/16/2006 |
| Last Update Date | 12/03/2023 |
| Medicare PECOS PAC ID | 7113989666 |
|---|---|
| Medicare Enrollment ID | O20041028000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225072671 | NPI | - | NPPES |
| 507420701 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2000160353 (Missouri) | Primary |
| Provider Name | Mohammed Haque |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1689604100 PECOS PAC ID: 6608780747 Enrollment ID: I20031113000653 |
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