Organization
MANZOOR TARIQ, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANZOOR A TARIQ M.D. (M.D.)
(636) 931-7111
Entity
Organization
Contact information
Practice address
1071 AIRPORT RD, FESTUS, MO 63028-4103
(636) 931-7111
Mailing address
1071 AIRPORT RD, FESTUS, MO 63028-4103
(636) 931-7111
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
133876
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203400247
—
MO
Enumeration date
11/14/2008
Last updated
11/14/2008
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