Provider Demographics
NPI:1083649024
Name:NIEMCZYK, MICHELE L (DO)
Entity type:Individual
Prefix:MISS
First Name:MICHELE
Middle Name:L
Last Name:NIEMCZYK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5701 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-367-2985
Practice Address - Street 1:11642 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6723
Practice Address - Country:US
Practice Address - Phone:314-838-8220
Practice Address - Fax:314-830-1873
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005017812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005017812OtherSTATE LICENSE
MO207489808Medicaid