Healthcare Provider Details

I. General information

NPI: 1235157710
Provider Name (Legal Business Name): MICHAEL S DIAMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8051
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-3000
  • Fax: 314-747-4511
Mailing address:
  • Phone: 314-747-3000
  • Fax: 314-747-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2002005546
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: