Healthcare Provider Details

I. General information

NPI: 1629021175
Provider Name (Legal Business Name): MICHAEL A SPECTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 DELMAR BLVD STE 215
SAINT LOUIS MO
63124-2168
US

IV. Provider business mailing address

8515 DELMAR BLVD STE 215
SAINT LOUIS MO
63124-2168
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-8484
  • Fax: 314-692-8488
Mailing address:
  • Phone: 314-692-8484
  • Fax: 314-692-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number423
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: