Basic Information
| Provider Information | |||||||||
| NPI: | 1376577825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182342120 | ||||||||
| FaxNumber: | 6186415806 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 S NEW BALLAS RD STE 6017B | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142514659 | ||||||||
| FaxNumber: | 3142515715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-115521 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 036-115521 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 2017029652 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.