Provider Demographics
NPI:1336288067
Name:MISTEROVICH, HOPE E (DO)
Entity Type:Individual
Prefix:DR
First Name:HOPE
Middle Name:E
Last Name:MISTEROVICH
Suffix:
Gender:F
Credentials:DO
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 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1925 W CHESTERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8686
Practice Address - Country:US
Practice Address - Phone:417-269-9060
Practice Address - Fax:417-269-9061
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR99267OtherARK BLUE SHIELD
MO164839OtherMO BLUE SHIELD
MO245737101Medicaid
MO184013230Medicare PIN
MO164839OtherMO BLUE SHIELD
AR99267OtherARK BLUE SHIELD