Provider Demographics
NPI:1114984242
Name:MIDWEST GASTROENTEROLOGY & HEPATOLOGY PC
Entity Type:Organization
Organization Name:MIDWEST GASTROENTEROLOGY & HEPATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-5660
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:#1001B
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-5660
Mailing Address - Fax:314-251-5663
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:#1001B
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-5660
Practice Address - Fax:314-251-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty