Provider Demographics
NPI:1831333905
Name:DALAL, ALIASGAR HUSAINI (MD)
Entity type:Individual
Prefix:DR
First Name:ALIASGAR
Middle Name:HUSAINI
Last Name:DALAL
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:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5095
Mailing Address - Country:US
Mailing Address - Phone:314-953-8250
Mailing Address - Fax:314-953-8255
Practice Address - Street 1:11125 DUNN RD STE 301
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-953-8250
Practice Address - Fax:314-953-8255
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61111853207XX0004X
MO2021039677207X00000X
FLME118279207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherAETNA
FLP01437051OtherRAILROAD MEDICARE
AZ010424Medicaid
FL012557200Medicaid
FLPENDINGOtherBSBS
FLP01437051OtherRAILROAD MEDICARE
AZ010424Medicaid