Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Omar Mudallal

Individual provider Internal Medicine Physician · NPI 1023369097

Omar Mudallal is an Internal Medicine Physician in Saint Louis, Missouri. Licensed in Illinois. Registered with an NPI since 2012.

Licensed in
IL
In the registry since
2012

Practice location Address checks out

915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone: (314) 652-4100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 036147331 (IL)

Record details

NPI number1023369097
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 30, 2012
Last updated in NPPESApril 2, 2024
Certification dateApril 2, 2024

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