Organization
IMDAD LONG TERM CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RIFFAT Y IMDAD M.D. (PRESIDENT)
(314) 651-6129
Entity
Organization
Contact information
Practice address
18 LOCHHAVEN LN, BALLWIN, MO 63021-8020
(636) 527-9595
(636) 527-9595
Mailing address
424 W 4TH ST, WATERLOO, IL 62298-1378
(618) 939-1193
(618) 939-7539
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2000160629
MO
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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