MEDICARE: MICHELLE GOETZ 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	207R00000X	Internal Medicine Physician	2010020693	MO
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	2011038209	MO

General Provider Information

NPI Number	:	1740591494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GOETZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 419052
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-9052
Country	:	US
Telephone Number	:	314-851-1000
Fax Number	:	314-851-4445

Provider Business Practice Location Address
First Line	:	555 MARYVILLE UNIVERSITY DR STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-5822
Country	:	US
Telephone Number	:	314-373-2675
Fax Number	:	314-851-4445

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	03/25/2026

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