Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 010557 | MO |
Y | 213EG0000X | General Practice | 010557 | MO |
NPI | 1003872508 |
---|---|
Provider Name | Dr. James Michael Hasik |
First Address | Des Peres, MO 63131-2246 |
Second Address | Saint Louis, MO 63106-1621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 08/07/2007 |