Healthcare Provider Details

I. General information

NPI: 1255378832
Provider Name (Legal Business Name): MIGUEL GELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 TESSON FERRY RD
SAINT LOUIS MO
63128-4056
US

IV. Provider business mailing address

PO BOX 411515
SAINT LOUIS MO
63141-3515
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-5888
  • Fax:
Mailing address:
  • Phone: 314-364-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036117188
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036117188
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2001010859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: