Provider Demographics
NPI:1962603159
Name:BHUTTO, SAQIB (MD)
Entity type:Individual
Prefix:DR
First Name:SAQIB
Middle Name:
Last Name:BHUTTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 189A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6377
Mailing Address - Fax:314-251-5864
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 189A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6377
Practice Address - Fax:314-251-5864
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2014-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2009002506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01109297OtherRAILROAD MEDICARE
MO1962603159Medicaid
MO152800107Medicare PIN