MEDICARE: DES PERES MEDICAL SPECIALIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	R9B88	MO

General Provider Information

NPI Number	:	1336216902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DES PERES MEDICAL SPECIALIST

Provider Business Mailing Address
First Line	:	PO BOX 790056
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	SUITE 408
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-821-3111
Fax Number	:	314-821-8846

Authorized Official
Title or Position	:	INTERNAL MEDICINE & CRITICAL CARE
Name	:	DR. MICHAEL DAVID IMPEY
Credential	:	D.O.
Telephone Number	:	314-821-3111

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/22/2020

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Directions to “DES PERES MEDICAL SPECIALIST ” Practice Location

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