Organization
QMB RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QASIM MUSTAFA BAJWA M.D (PRESIDENT)
(314) 550-3494
Entity
Organization
Contact information
Practice address
35629 HIGHWAY 72, SALEM, MO 65560-7217
(314) 550-3494
(636) 230-5732
Mailing address
104 COUNTRY CREEK CT, BALLWIN, MO 63011-3812
(314) 550-3494
(636) 230-5732
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
102285
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207708611
—
MO
Enumeration date
02/05/2013
Last updated
02/05/2013
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