Provider Demographics
NPI:1437193877
Name:NORDLICHT, SCOTT MONROE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MONROE
Last Name:NORDLICHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-1291
Mailing Address - Fax:314-996-3268
Practice Address - Street 1:1020 N MASON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6300
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-996-3268
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7545207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201324472Medicaid
MO121010183Medicare PIN
MO000093029Medicare PIN
MO121010183Medicaid
IL$$$$$$$$$Medicaid