MEDICARE: MICHAEL J SPEZIA DO INC

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	302R00000X	Health Maintenance Organization	R8660	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912229147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J SPEZIA DO INC

Provider Business Mailing Address
First Line	:	23 N OAKS PLZ
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-2917
Country	:	US
Telephone Number	:	314-385-7161
Fax Number	:	314-385-3502

Provider Business Practice Location Address
First Line	:	23 N OAKS PLZ
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-2917
Country	:	US
Telephone Number	:	314-385-7161
Fax Number	:	314-385-3502

Authorized Official
Title or Position	:	DOCTOR
Name	:	MICHAEL JOSEPH SPEZIA
Credential	:	D.O.
Telephone Number	:	314-385-7161

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	01/23/2012

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Directions to “MICHAEL J SPEZIA DO INC ” Practice Location

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