Provider Demographics
NPI:1265413827
Name:PRESTI, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:PRESTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:915 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-289-6434
Mailing Address - Fax:
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-543-5911
Practice Address - Fax:314-543-5914
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3H59207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156440049OtherMEDICARE PTAN #
E61044Medicare UPIN