| Michael Cannon, MD Personalized Medicine, LLC | |
|
16216 Baxter Rd Ste 340 Chesterfield MO 63017-4778 | |
| (314) 325-8925 | |
| Not Available |
| Full Name | Michael Cannon, MD Personalized Medicine, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 16216 Baxter Rd Ste 340, Chesterfield, Missouri |
| Authorized Official Name and Position | Michael Cannon (OWNER/ MD) |
| Authorized Official Contact | 3145742851 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Cannon, MD Personalized Medicine, LLC Po Box 221240 Kirkwood MO 63122-8240 | Michael Cannon, MD Personalized Medicine, LLC 16216 Baxter Rd Ste 340 Chesterfield MO 63017-4778 Ph: (314) 325-8925 |
| NPI Number | 1326769175 |
|---|---|
| Provider Enumeration Date | 09/09/2022 |
| Last Update Date | 09/09/2022 |
| Certification Date | 09/09/2022 |
| Medicare PECOS PAC ID | 0042688228 |
|---|---|
| Medicare Enrollment ID | O20221118001325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326769175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | () | Primary |
| Provider Name | Michael E Cannon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154348761 PECOS PAC ID: 4587714076 Enrollment ID: I20090603000491 |
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