Provider Demographics
NPI:1194806497
Name:EIDELMAN, ZAMIR (MD)
Entity type:Individual
Prefix:
First Name:ZAMIR
Middle Name:
Last Name:EIDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-5900
Mailing Address - Fax:314-996-5910
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:STE 387C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-5900
Practice Address - Fax:314-996-5910
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208533034Medicaid
MO103582OtherMEDICAL LICENSE
MOBE4913249OtherBNDD
MO20832OtherBNDD
MO001013395Medicare ID - Type Unspecified
MOBE4913249OtherBNDD