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General NPI Number Information
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NPI Number | 1144726084
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Entity Type | Individual
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Provider Name | NIMROD SHABTAI BARASHI GOZAL MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2018
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 111 SAINT LUKES CENTER DR STE 24B
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3509
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Country | US
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Telephone | 636-685-7830
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Fax | 314-590-5971
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Provider Business Mailing Address
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Address Line | 445 E OHIO ST APT 1703
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City | CHICAGO
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State | IL
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Zip | 60611-4685
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Country | US
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Telephone | 312-989-5017
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2024000198
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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