Healthcare Provider Details

I. General information

NPI: 1942289459
Provider Name (Legal Business Name): MICHAEL J FLEISSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/29/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR STE W1
BELLEVILLE IL
62226-5359
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-3066
  • Fax: 618-233-3180
Mailing address:
  • Phone: 618-233-3066
  • Fax: 618-233-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD100821
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number100821
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.084308
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: