Provider Demographics
NPI:1326049636
Name:NOGALSKI, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:NOGALSKI
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 1:1050 OLD DES PERES RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1865
Mailing Address - Country:US
Mailing Address - Phone:314-569-0612
Mailing Address - Fax:314-966-0664
Practice Address - Street 1:1050 OLD DES PERES RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1865
Practice Address - Country:US
Practice Address - Phone:314-569-0612
Practice Address - Fax:314-966-0664
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4319113OtherAETNA
MO18526OtherANTHEM
MO200044043OtherMEDICARE RAILROAD
MO122984OtherCOVENTRY
MO0900139OtherUNITED HEALTHCARE
MO212913OtherHEALTHLINK
MO30495443OtherCIGNA
MO4208030001Medicare NSC
MO212913OtherHEALTHLINK
MO18526OtherANTHEM