Provider Demographics
NPI:1912229147
Name:MICHAEL J SPEZIA DO INC
Entity Type:Organization
Organization Name:MICHAEL J SPEZIA DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SPEZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-385-7161
Mailing Address - Street 1:23 N OAKS PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-2917
Mailing Address - Country:US
Mailing Address - Phone:314-385-7161
Mailing Address - Fax:314-385-3502
Practice Address - Street 1:23 N OAKS PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2917
Practice Address - Country:US
Practice Address - Phone:314-385-7161
Practice Address - Fax:314-385-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8660302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240274704Medicaid
MO000009022Medicare UPIN