Individual
ELIE C AZRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12266 DE PAUL DR STE 205, BRIDGETON, MO 63044-2514
(314) 218-2300
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-6119
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036110194
IL
207RC0000X
Cardiovascular Disease Physician
Primary
106181
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000013096
ESSENCE
—
01
—
072208
FMH
—
01
—
183083
MOBC/BS, BLUE CHOICE
MO
01
—
185761V3831
GHP
—
05
—
204870026
—
MO
01
—
22724
HEALTHCARE USA
—
01
—
431098908
UHC
—
01
—
435756
HEALTHLINK
—
01
—
9779268001
CIGNA
—
01
—
G57442
MERCY
—
01
—
P00149798
ILRRMCR
IL
01
—
P00279137
MORRMCR
MO
01
—
P00289356
MORRMCR
MO
Enumeration date
08/25/2005
Last updated
10/19/2020
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