Individual
MICHAEL MARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10296 BIG BEND RD, SUITE 205, SAINT LOUIS, MO 63122
(314) 315-9911
Mailing address
215 DUNN RD, FLORISSANT, MO 63031-7928
(314) 315-9913
(317) 872-8069
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R5P91
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00199673
PALMETTO RR MEDICARE
MO
Enumeration date
05/04/2006
Last updated
08/23/2018
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