Healthcare Provider Details

I. General information

NPI: 1396735734
Provider Name (Legal Business Name): MICHAEL JOSEPH RESCHAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 CLAYTON RD STE 310
SAINT LOUIS MO
63117-1639
US

IV. Provider business mailing address

6744 CLAYTON RD STE 310
SAINT LOUIS MO
63117-1639
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-6600
  • Fax: 314-367-5982
Mailing address:
  • Phone: 314-367-6600
  • Fax: 314-367-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number114706
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: