Healthcare Provider Details

I. General information

NPI: 1447575964
Provider Name (Legal Business Name): MICHAEL RYAN REIDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 101
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 101
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-880-6676
  • Fax: 314-525-4365
Mailing address:
  • Phone: 314-880-6676
  • Fax: 314-525-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2018005681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: