MICHAEL K WOLVERSON (NPI# 1972523322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972523322 |
| Entity Type | Individual |
| Full Name | MICHAEL K WOLVERSON |
| Credential | MD |
| Practice Address |
3635 Vista Ave Saint Louis MO 63110-2539 |
| Mailing Address |
3691 Rutger St Provider Enrollment Saint Louis MO 63110-2515 |
| Practice Telephone | 3142685783 |
| Practice Fax Number | 3142685116 |
| Mailing Telephone | 3149774440 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-03-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
R8237 | MO | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
R8237 | MO | Allopathic & Osteopathic Physicians |
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
R8237 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
3635 VISTA AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-2539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891790689 | Rajeswari Chintapalli | Anesthesiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2005-06-17 |
| 1932711389 | Breezy Summer Stanley | Nurse Practitioner | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-08-18 |
| 1235756842 | Trisha Ann Janis | Nurse Practitioner | 3635 Vista Ave, Saint Louis, MO 63110-2500 | 2020-06-30 |
| 1780207167 | Michelle Reale | Speech-Language Pathologist | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-20 |
| 1801418926 | Jason Adam Horowitz | Student in an Organized Health Care Education/Training Program | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-12 |
| 1255953378 | Luke Andrew Momper | Student in an Organized Health Care Education/Training Program | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-12 |
| 1063034197 | Tyler Daniel Ragsdale | Student in an Organized Health Care Education/Training Program | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-12 |
| 1417579541 | Kelyn N Pittman | Student in an Organized Health Care Education/Training Program | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-12 |
| 1881216901 | Purav Sudhir Brahmbhatt | Student in an Organized Health Care Education/Training Program | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-12 |
| 1578185989 | Feras Kaid | Radiologic Technologist | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2020-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609130566 | Kristin Harris Drake | Radiology | 621 S New Ballas Rd Ste 23a, Saint Louis, MO 63141 | 2012-06-26 |
| 1093083016 | William G Crawford | Radiology | 61 Crestwood Dr, Saint Louis, MO 63105-3020 | 2011-12-05 |
| 1558657643 | Joseph Gary Livingston | Radiology | One Barnes-jewsih Hospital Plaza, Mailstop 90-09-355, Saint Louis, MO 63110 | 2011-06-27 |
| 1013219344 | Pure Imaging LLC | Radiology | 12345 West Bend Drive, Saint Louis, MO 63128-2104 | 2010-11-18 |
| 1881884658 | Zhengming Gu | Radiology | 9240 Radiom Dr, Saint Louis, MO 63123-5545 | 2007-07-27 |
| 1306057310 | Mohammed Ali Abbas | Radiology | 1402 S Grand Blvd Rm 260, Saint Louis, MO 63104-1004 | 2007-05-24 |
| 1104040963 | Saadoon Kadir | Radiology | 2909 Netherton Dr, Saint Louis, MO 63136-4677 | 2007-04-12 |
| 1376612739 | Carl Joseph Aschkenasi | Radiology | 898 Alanson Dr, Saint Louis, MO 63132-5039 | 2006-11-07 |
| 1629182829 | Jeffery A Hardy | Radiology | 2344 Hampton Ave, Saint Louis, MO 63139-2909 | 2006-08-18 |
| 1124132436 | Alfred D Shaplin | Radiology | 1034 S Brentwood Blvd Ste 280, Saint Louis, MO 63117-1221 | 2006-08-17 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.