Healthcare Provider Details

I. General information

NPI: 1265413827
Provider Name (Legal Business Name): MICHAEL EDWARD PRESTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD SUITE 404
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5911
  • Fax: 314-543-5914
Mailing address:
  • Phone: 314-289-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR3H59
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: