Basic Information
| Provider Information | |||||||||
| NPI: | 1558743138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAKASHIMA-MORAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148511000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1167 FORTUNE BLVD | ||||||||
| Address2: | |||||||||
| City: | SHILOH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622697377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182076900 | ||||||||
| FaxNumber: | 6182076901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2015 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.145202 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.