Healthcare Provider Details

I. General information

NPI: 1356342570
Provider Name (Legal Business Name): MICHAEL CLARKE TRUEBLOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 DOCTORS PARK ORTHOPAEDIC ASSOCIATES OF SOUTHEAST MISSOURI PC
CAPE GIRARDEAU MO
63703-4928
US

IV. Provider business mailing address

9 BIENVILLE AVE ORTHOPAEDIC ASSOCIATES OF SOUTHEAST MISSOURI PC
CAPE GIRARDEAU MO
63701-1944
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-8257
  • Fax: 573-335-8424
Mailing address:
  • Phone: 573-335-8257
  • Fax: 573-335-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR8424
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: