FAREESA KHAN LLC (NPI# 1780923490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780923490 |
| Entity Type | Organization |
| Organization Name | FAREESA KHAN LLC |
| Practice Address |
10004 Kennerly Rd Ste 255a Saint Louis MO 63128-2184 |
| Mailing Address |
Po Box 410085 Saint Louis MO 63141-0085 |
| Practice Telephone | 3142709880 |
| Mailing Telephone | 6366753107 |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2020-07-10 |
| Authorized Official Name | FAREESA G KHAN (OWNER) |
| Authorized Official Telephone | 6366753107 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VF0040X |
Obstetrics & Gynecology Specialization: Female Pelvic Medicine and Reconstructive Surgery |
112917 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 203820014 | 05 |
| Street Address |
10004 KENNERLY RD STE 255A |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2184 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 207VF0040X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Female Pelvic Medicine and Reconstructive Surgery |
| A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them. |
| Notes: Source: American Board of Medical Specialties, 2011. [1/1/2012: new] Resources: www.abms.org |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003280652 | Midwest Urogynecology, LLC | Obstetrics & Gynecology | 2325 Dougherty Ferry Rd, Suite 206, Saint Louis, MO 63122-3356 | 2015-11-19 |
| 1619177680 | Sara C Wood | Obstetrics & Gynecology | 621 S New Ballas Rd, Suite 2002b, Saint Louis, MO 63141 | 2007-07-18 |
| 1629047626 | Dionysios K Veronikis | Obstetrics & Gynecology | 621 S New Ballas Rd, Suite 2002 Tower B, Saint Louis, MO 63141-8232 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184192239 | Curators of The University of Missouri | Obstetrics & Gynecology | 4040 Range Line St Ste 100, Columbia, MO 65202-1605 | 2018-11-07 |
| 1376932244 | Midwest Urogynecology, LLC | Obstetrics & Gynecology | 12 Carter Ct, Olivette, MO 63132-2002 | 2015-01-15 |
| City | SAINT LOUIS |
| Zip Code | 63128 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.