Provider Demographics
NPI:1144726084
Name:BARASHI GOZAL, NIMROD SHABTAI (MD)
Entity type:Individual
Prefix:
First Name:NIMROD
Middle Name:SHABTAI
Last Name:BARASHI GOZAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:445 E OHIO ST APT 1703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4685
Mailing Address - Country:US
Mailing Address - Phone:312-989-5017
Mailing Address - Fax:
Practice Address - Street 1:111 SAINT LUKES CENTER DR STE 24B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:636-685-7830
Practice Address - Fax:314-590-5971
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024000198208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200094624Medicaid