=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457354276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID J PRELUTSKY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2340 HAMPTON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63139-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-647-2200
-----------------------------------------------------
Fax | 314-647-4172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2340 HAMPTON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63139-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-647-2200
-----------------------------------------------------
Fax | 314-647-4172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | R8B23
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------