Provider Demographics
NPI:1457354276
Name:PRELUTSKY, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:PRELUTSKY
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:PO BOX 952024
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2024
Mailing Address - Country:US
Mailing Address - Phone:314-647-2200
Mailing Address - Fax:314-647-4172
Practice Address - Street 1:2340 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2909
Practice Address - Country:US
Practice Address - Phone:314-647-2200
Practice Address - Fax:314-647-4172
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8B23207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4593254OtherAETNA
102123OtherHEALTHLINK
MO24387OtherBLUE CROSS BLUE SHIELD
102123OtherHEALTHLINK