Provider Demographics
NPI:1588794689
Name:ARDEKANI, AHMAD BEHESHTI (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:BEHESHTI
Last Name:ARDEKANI
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:SUITE 310A
Mailing Address - Street 2:10004 KENNERLY RD
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-5117
Mailing Address - Country:US
Mailing Address - Phone:314-843-3310
Mailing Address - Fax:314-843-8825
Practice Address - Street 1:SUITE 310A
Practice Address - Street 2:10004 KENNERLY RD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5117
Practice Address - Country:US
Practice Address - Phone:314-843-3310
Practice Address - Fax:314-843-8825
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO359412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
198301OtherVALUE BEHAVIORAL HEALTH
101010OtherHEALTHLINK
181942OtherALLIANCE BCBS
MO201270717Medicaid
260004802498769OtherTRICARE NORTH REGION
31744OtherGROUP HEALTH PLAN
1542794OtherUNITED BEHAVIORAL HEALTH
015927000OtherMAGELLAN BEHAVIORAL HEALT
129999OtherVALUE OPTIONS
12031OtherCIGNA GENERAL MOTORS
260004802OtherRR MEDICARE PART B
31744OtherCMR CARE MANAGEMENT RESOU
9534OtherBCBS OF MISSOURI
A10513OtherMERCY HEALTH PLAN
198301OtherVALUE BEHAVIORAL HEALTH
MO329475560Medicare PIN