| Infectious Diseases Pc | |
|
10004 Kennerly Road #171b St. Louis MO 63128 | |
| (314) 821-0900 | |
| (800) 556-8932 |
| Full Name | Infectious Diseases Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10004 Kennerly Road, St. Louis, Missouri |
| Authorized Official Name and Position | Aamina B Akhtar (PRESIDENT) |
| Authorized Official Contact | 3148210900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases Pc 10004 Kennerly Road #171b St. Louis MO 63128 Ph: (314) 821-0900 | Infectious Diseases Pc 10004 Kennerly Road #171b St. Louis MO 63128 Ph: (314) 821-0900 |
| NPI Number | 1720055452 |
|---|---|
| Provider Enumeration Date | 03/01/2006 |
| Last Update Date | 08/11/2016 |
| Medicare PECOS PAC ID | 6305880956 |
|---|---|
| Medicare Enrollment ID | O20050614001062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720055452 | NPI | - | NPPES |
| 506049501 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Secondary |
| Provider Name | Aamina B Akhtar |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1124095831 PECOS PAC ID: 6709820418 Enrollment ID: I20050614000668 |
| Provider Name | Rajashree Gottimukkula |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1528246071 PECOS PAC ID: 9032281787 Enrollment ID: I20080711000558 |
| Provider Name | Ramona E Aitken |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1124095864 PECOS PAC ID: 7416011960 Enrollment ID: I20090127000642 |
| Provider Name | Manokiran Patri |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1649204173 PECOS PAC ID: 3971594748 Enrollment ID: I20090928000044 |
| Provider Name | Shephali H Wulff |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1174789747 PECOS PAC ID: 4587836143 Enrollment ID: I20111004000707 |
| Provider Name | Lee K Yong |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1952538522 PECOS PAC ID: 7214109354 Enrollment ID: I20111013000300 |
| Provider Name | Blessy John |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548524218 PECOS PAC ID: 3779895271 Enrollment ID: I20170814000854 |
| Provider Name | Ali Etemady-deylamy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760864888 PECOS PAC ID: 4486946076 Enrollment ID: I20190326001069 |
| Provider Name | Uchenna Ikediobi |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1598085771 PECOS PAC ID: 7012227499 Enrollment ID: I20220729001012 |
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