Provider Demographics
NPI:1790777225
Name:LEVY, NAT T (MD)
Entity Type:Individual
Prefix:DR
First Name:NAT
Middle Name:T
Last Name:LEVY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:6698 KEATON CORPORATE PKWY
Practice Address - Street 2:STE: 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8724
Practice Address - Country:US
Practice Address - Phone:636-928-0215
Practice Address - Fax:636-928-0218
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-03-10
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Provider Licenses
StateLicense IDTaxonomies
MO113413207RC0200X, 207RP1001X
IL036.107143207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92000Medicare UPIN