Healthcare Provider Details

I. General information

NPI: 1740591494
Provider Name (Legal Business Name): MICHELLE GOETZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MARYVILLE UNIVERSITY DR STE 240
SAINT LOUIS MO
63141-5822
US

IV. Provider business mailing address

PO BOX 419052
SAINT LOUIS MO
63141-9052
US

V. Phone/Fax

Practice location:
  • Phone: 314-373-2675
  • Fax: 314-851-4445
Mailing address:
  • Phone: 314-851-1000
  • Fax: 314-851-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2010020693
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2011038209
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: