Provider Demographics
NPI:1972596757
Name:NAUSHAD, ABDUL NAEEM (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:NAEEM
Last Name:NAUSHAD
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 1:622 COLLINS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-638-1506
Mailing Address - Fax:636-638-1507
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:573-776-1100
Practice Address - Fax:573-776-1107
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002024819207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO794101OtherHEALTHLINK HMO
MO7475459OtherAETNA
MO1972596757Medicaid
MO176806OtherBLUE CROSS BLUE SHIELD
MO567896OtherHEALTHLINK PPO
AR158238001Medicaid
MO305205OtherGHP
MO00002259957OtherUHC
MOP00094934OtherMCRR
MOH73205Medicare UPIN
AR158238001Medicaid
MOMA2027001Medicare PIN
MO00002259957OtherUHC
MOMA2027001Medicare PIN
MOH73205Medicare UPIN
MO96225OtherHCUSA
MO1972596757Medicaid