Individual
DAVID J NYQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226
(618) 257-6220
(618) 257-6679
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36076188
IL
208M00000X
Hospitalist Physician
Primary
036-076188
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006015346
BLUE CROSS BLUE SHIELD OF
IL
01
—
0104775
UNITED HEALTH CARE UHC
—
05
—
036076188
—
IL
01
—
080174497
RAILROAD MEDICARE
—
01
—
133289
CMR A DIVISION OF GHP
—
01
—
187771
HEALTH LINK
—
01
—
4080250
AETNA
—
Enumeration date
06/06/2006
Last updated
02/23/2021
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