Individual
DR. GHAZAL SHADMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY, SAINT LOUIS, MO 63110-1016
(314) 362-7200
(314) 747-4189
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-7200
(314) 747-4189
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
2025022425
MO
2085R0202X
Diagnostic Radiology Physician
Primary
2025022425
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200113628
—
MO
Enumeration date
06/23/2020
Last updated
08/13/2025
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