Provider Demographics
NPI:1932204740
Name:MICHAEL A. SPECTER INC.
Entity type:Organization
Organization Name:MICHAEL A. SPECTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPECTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-692-8484
Mailing Address - Street 1:8515 DELMAR BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2168
Mailing Address - Country:US
Mailing Address - Phone:314-692-8484
Mailing Address - Fax:314-692-8488
Practice Address - Street 1:8515 DELMAR BLVD STE 215
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2168
Practice Address - Country:US
Practice Address - Phone:314-692-8484
Practice Address - Fax:314-692-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000423MO213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000423OtherMISSOURI STATE LICENSE #
MOSP300800422MOMedicaid
MOT42872Medicare UPIN
MO000021533MOMedicare ID - Type UnspecifiedMEDICARE NUMBER