MALAK ITANI (NPI# 1750728192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750728192 |
| Entity Type | Individual |
| Full Name | MALAK ITANI |
| Credential | M.D. |
| Practice Address |
510 S Kingshighway Blvd Saint Louis MO 63110-1016 |
| Practice Telephone | 3143621053 |
| Mailing Telephone | 3143621053 |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2018-05-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207U00000X | Nuclear Medicine | MD60666593 | WA | Allopathic & Osteopathic Physicians |
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
2017043456 | MO | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD60666593 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1750728192 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1959 Ne Pacific Street Box 357115 Nw040 Box 357115nw04, Seattle, WA 981950001 | 2065987370 |
| Street Address |
510 S KINGSHIGHWAY BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033107982 | Laurie L Fajardo | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2005-10-13 |
| 1902442650 | Amir Iravani Tabrizipour | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-11-18 |
| 1942850078 | Paul-robert Derenoncourt | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-09-20 |
| 1659861615 | Alexander Baireddy Reddy | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110 | 2018-05-15 |
| 1508356700 | Daniel Crawford | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-05-14 |
| 1154826675 | Eric Weiner | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-27 |
| 1447754767 | Allison L Schell | Physician Assistant | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-21 |
| 1407381262 | Philip Andrew Velez | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2017-04-28 |
| 1154778959 | Jimmy Xu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2016-05-21 |
| 1124402573 | Wei Wang | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003353152 | E-cloud Radiology LLC | Radiology | 7304 Stream Valley Ct, Saint Louis, MO 63129-5291 | 2017-01-27 |
| 1184828410 | John Gerard Ryan | Radiology | Mallinckrodt Institute of Radiology - Barnesjewish Hosp, 510 South Kingshighway Blvd., Saint Louis, MO 63110 | 2007-06-12 |
| 1174527584 | Edward O'brien | Radiology | 9930 Watson Rd, Saint Louis, MO 63126-1827 | 2005-06-13 |
| 1366861841 | William Cassidy Wilson Iv | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-04-10 |
| 1720427982 | Aaron Joseph Mintz | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1076 | 2013-06-21 |
| 1710242516 | Maria Zulfiqar | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2012-07-08 |
| 1255457271 | Yihua Zhou | Radiology | 3635 Vista At Grand, Radiology Dept - Sluh, Saint Louis, MO 63110-0250 | 2007-03-21 |
| 1619081940 | Professional Imaging LLC | Radiology | 777 S New Ballas Rd, Suite 005, Saint Louis, MO 63141-8705 | 2006-08-17 |
| 1194735282 | Numan C Balci | Radiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2006-08-09 |
| 1972523322 | Michael K Wolverson | Radiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2006-07-20 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.