Organization
EDEN PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETIHAD SHAKIR AL-FALAHI M.D (PRESIDENT)
(314) 983-0606
Entity
Organization
Contact information
Practice address
763 S NEW BALLAS RD, SUITE 220, SAINT LOUIS, MO 63141-8704
(314) 983-0606
(314) 983-0608
Mailing address
763 S NEW BALLAS RD STE 220, SAINT LOUIS, MO 63141-8711
(314) 983-0606
(314) 983-0608
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD101423
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114721
BLUE CROSS BLUE SHIELD
MO
01
—
1210150
UNITED HEALTHCARE
MO
01
—
214028
GROUP HEALTH PLAN
MO
01
—
286120
HEALTHLINK
MO
01
—
5013620
AETNA
MO
01
—
G10654
MERCY HEALTH PLAN
MO
Enumeration date
09/15/2006
Last updated
08/22/2020
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