Provider Demographics
NPI:1316928369
Name:SPEZIA, MICHAEL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SPEZIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:23 N OAKS PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-2917
Mailing Address - Country:US
Mailing Address - Phone:314-385-7161
Mailing Address - Fax:314-382-3502
Practice Address - Street 1:23 N OAKS PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2917
Practice Address - Country:US
Practice Address - Phone:314-385-7161
Practice Address - Fax:314-382-3502
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240274704Medicaid
MO431183760Medicaid
MO000009022Medicare ID - Type Unspecified
MOD41720Medicare UPIN