MEDICARE: MICHAEL A PATTERSON D.O.

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	106797	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	:	1699857151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A PATTERSON D.O.

Provider Business Mailing Address
First Line	:	660 MASON RIDGE CENTER DR STE 300
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8512
Country	:	US
Telephone Number	:	314-448-3791
Fax Number	:	314-483-3791

Provider Business Practice Location Address
First Line	:	1501 PROFESSIONAL DR
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-3809
Country	:	US
Telephone Number	:	636-547-7300
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/22/2025

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