Individual
ALI ETEMADY-DEYLAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128
(314) 525-1328
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101021789
MI
207R00000X
Internal Medicine Physician
2016015544
MO
207R00000X
Internal Medicine Physician
2017016664
MO
207RI0200X
Infectious Disease Physician
Primary
2017016664
MO
Other
Enumeration date
06/25/2015
Last updated
08/17/2023
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