MEDICARE: MICHAEL P. NOGALSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	103285	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200044043	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4319113	OTHER	MO	AETNA
2	18526	OTHER	MO	ANTHEM
4	122984	OTHER	MO	COVENTRY
5	0900139	OTHER	MO	UNITED HEALTHCARE
6	212913	OTHER	MO	HEALTHLINK
7	30495443	OTHER	MO	CIGNA

General Provider Information

NPI Number	:	1326049636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL P. NOGALSKI M.D.

Provider Business Mailing Address
First Line	:	1050 OLD DES PERES RD.
Second Line	:	SUITE 100
City	:	ST. LOUIS
State	:	MO
Zip	:	63131-1865
Country	:	US
Telephone Number	:	314-569-0612
Fax Number	:	314-966-0664

Provider Business Practice Location Address
First Line	:	1050 OLD DES PERES RD.
Second Line	:	SUITE 100
City	:	ST. LOUIS
State	:	MO
Zip	:	63131-1865
Country	:	US
Telephone Number	:	314-569-0612
Fax Number	:	314-966-0664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/23/2021

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