Provider Demographics
NPI:1063998953
Name:ISHRAT, SYEDA RUMANA (MD)
Entity type:Individual
Prefix:
First Name:SYEDA RUMANA
Middle Name:
Last Name:ISHRAT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-919-2700
Mailing Address - Fax:314-919-2777
Practice Address - Street 1:801 HAZELWEST DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1754
Practice Address - Country:US
Practice Address - Phone:314-919-2700
Practice Address - Fax:314-919-2777
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024048904207R00000X
NY311532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine