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General NPI Number Information
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NPI Number | 1356861637
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Entity Type | Individual
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Provider Name | BASIA MARIE MICHALSKI - MCNEELY MD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 969 N MASON RD DIV IM DERMATOLOGY, STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6282
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Country | US
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Telephone | 314-996-8810
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Fax | 888-682-0525
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-996-8810
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Fax | 888-682-0525
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2022016236
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2022016236
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License Number State | MO
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