Healthcare Provider Details

I. General information

NPI: 1952038465
Provider Name (Legal Business Name): MR. DAVID MICHAEL SCHOTTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEMORIAL DR STE 230
ALTON IL
62002-6704
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-8666
  • Fax: 618-433-6125
Mailing address:
  • Phone: 618-465-8666
  • Fax: 618-433-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041599340
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2025014034
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2025014034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: