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General NPI Number Information
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NPI Number | 1639039936
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS PIESCHEL
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Gender | Male
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1 SAINT ELIZABETH BLVD # 3000
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City | O FALLON
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State | IL
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Zip | 62269-1099
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Country | US
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Telephone | 618-234-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 397 BLUE BIRD LN
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City | TROY
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State | IL
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Zip | 62294-2109
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Country | US
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Telephone | 218-349-3727
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 209.033858
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License Number State | IL
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