Provider Demographics
NPI:1750303335
Name:ENGELS, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ENGELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 WESTPORT PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3109
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:3015 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-996-5180
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5H852085R0202X
IL0361124382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1390OtherMO BLUE
5777OtherHCARE USA
100569OtherH LINK
202673208OtherMC MCAID
16850OtherBLUE CHOICE
300066991OtherRR CARE
202673208OtherMO CAID
020012444OtherMO CARE
431725842MIDOtherMERCY
E39928OtherGATE WAY
1600224OtherPH PLAN
2781OtherGHP
300066984OtherRR CARE
014013128OtherMO CARE
0006021895OtherIL BLUE
020012444OtherCARE
398025OtherHLT PART
MO020012444Medicare PIN
16850OtherBLUE CHOICE