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General NPI Number Information
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NPI Number | 1073505178
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Entity Type | Individual
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Provider Name | MICHAEL J ZEREGA MD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 200 BREVCO PLZ SUITE 208
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2949
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Country | US
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Telephone | 636-561-9020
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Fax | 636-561-6208
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Provider Business Mailing Address
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Address Line | 200 BREVCO PLZ SUITE 208
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2949
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Country | US
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Telephone | 636-561-9020
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Fax | 636-561-6208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2000154596
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License Number State | MO
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