Basic Information
| Provider Information | |||||||||
| NPI: | 1578554762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABODEELY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Practice Location | |||||||||
| Address1: | 9930 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631261827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34620 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 206589 | 01 | MO | HEALTHLINK | OTHER | 5872678 | 01 | MO | AETNA | OTHER | 200258010 | 05 | MO | MEDICAID | 1600797 | 01 | MO | UHC | OTHER | 000000010593 | 01 | MO | ESSENCE | OTHER | 65413 | 01 | MO | GHP | OTHER | 144352 | 01 | MO | BCBS | OTHER | 5206V34311 | 01 | MO | HEALTHCARE USA | OTHER | A12785 | 01 | MO | MERCY MC PL | OTHER |