Provider Demographics
NPI:1356861637
Name:MICHALSKI - MCNEELY, BASIA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:BASIA
Middle Name:MARIE
Last Name:MICHALSKI - MCNEELY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-996-8810
Mailing Address - Fax:888-682-0525
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6282
Practice Address - Country:US
Practice Address - Phone:314-996-8810
Practice Address - Fax:888-682-0525
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022016236207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200061526Medicaid