Individual
DR. MICHAEL S. MORITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141
(314) 251-6031
(314) 251-6343
Mailing address
11475 OLDE CABIN RD STE 200, SAINT LOUIS, MO 63141-7129
(314) 991-8210
(314) 991-8206
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
2017010079
MO
2085R0202X
Diagnostic Radiology Physician
Primary
2017010079
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407118318
—
MO
05
—
ENROLLED
—
IL
Enumeration date
06/15/2012
Last updated
08/17/2018
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