Healthcare Provider Details

I. General information

NPI: 1477717080
Provider Name (Legal Business Name): MILTON OLUDHE OCHIENG' M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY STE 108
O FALLON MO
63368-2206
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-1073
  • Fax: 636-344-1075
Mailing address:
  • Phone: 636-344-1073
  • Fax: 636-344-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2014012514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: