MEDICARE: DR. MICHAEL T RAILEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R9336	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023061926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL T RAILEY MD

Provider Business Mailing Address
First Line	:	6125 CLAYTON AVE
Second Line	:	STE 222
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3265
Country	:	US
Telephone Number	:	314-768-3204
Fax Number	:	314-768-3940

Provider Business Practice Location Address
First Line	:	6125 CLAYTON AVE
Second Line	:	STE 222
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3265
Country	:	US
Telephone Number	:	314-768-3685
Fax Number	:	314-768-3940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/12/2011

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