Provider Demographics
NPI:1053390484
Name:RASHID A DALAL MD PC
Entity type:Organization
Organization Name:RASHID A DALAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-9500
Mailing Address - Street 1:7 BEAVER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5497
Mailing Address - Country:US
Mailing Address - Phone:618-239-9500
Mailing Address - Fax:618-239-9555
Practice Address - Street 1:5003 N ILLINOIS ST STE 1
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3419
Practice Address - Country:US
Practice Address - Phone:618-239-9500
Practice Address - Fax:618-239-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG1905OtherRR MEDICARE
IL036090043Medicaid
110184061OtherRR MEDICARE
MO203771902Medicaid
IL036090043Medicaid
MO000094127Medicare PIN
211925Medicare PIN
DG1905OtherRR MEDICARE