MEDICARE: TOCHUKWU MICHELLE PATRICK

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1265114235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOCHUKWU MICHELLE PATRICK

Provider Business Mailing Address
First Line	:	1430 OLIVE ST STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2303
Country	:	US
Telephone Number	:	314-206-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	12355 DE PAUL DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2580
Country	:	US
Telephone Number	:	314-344-7101
Fax Number	:

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ TOCHUKWU MICHELLE PATRICK ” Practice Location

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