Provider Demographics
NPI:1386658235
Name:SHARIFF, ANJUM (MD)
Entity type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:SHARIFF
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2338
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-653-4300
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010085482085R0202X
IL0361050312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1601682OtherPH PLAN
MO205298409Medicaid
300121429OtherRR MEDICARE
431725842MIDOtherMERCY
46069OtherHCARE USA
1390OtherMO BLUE
2781OtherGHP
P00053279OtherRR MEDICARE