Provider Demographics
NPI:1073505178
Name:ZEREGA, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ZEREGA
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 1:200 BREVCO PLZ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2949
Mailing Address - Country:US
Mailing Address - Phone:636-561-9020
Mailing Address - Fax:636-561-6208
Practice Address - Street 1:200 BREVCO PLZ
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2949
Practice Address - Country:US
Practice Address - Phone:636-561-9020
Practice Address - Fax:636-561-6208
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154596207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1073505178Medicaid
MOP01015409OtherRAILROAD MEDICARE
18943OtherBC BS MO
MO1073505178Medicaid
MOMA1838009Medicare PIN