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Individual

DR. IMAAD RAZZAQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12266 DE PAUL DR STE 205, BRIDGETON, MO 63044-2514
(314) 218-2300
Mailing address
11125 DUNN RD STE 204, SAINT LOUIS, MO 63136-6188

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
2018017496
MO
207RC0000X
Cardiovascular Disease Physician
62022-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
2011018675

Other

Enumeration date
07/20/2011
Last updated
12/09/2021
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