Healthcare Provider Details

I. General information

NPI: 1376577825
Provider Name (Legal Business Name): MICHAEL WILLIAM NASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 S GEYER RD
SAINT LOUIS MO
63127-1203
US

IV. Provider business mailing address

3637 S GEYER RD
SAINT LOUIS MO
63127-1203
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1887
  • Fax: 314-525-1868
Mailing address:
  • Phone: 314-525-1887
  • Fax: 314-525-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017029652
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-115521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: