Healthcare Provider Details

I. General information

NPI: 1447814702
Provider Name (Legal Business Name): MICHELLE RENEE PETRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD
SAINT LOUIS MO
63117-1997
US

IV. Provider business mailing address

505 FAIRWOOD HILLS RD
O FALLON IL
62269-3562
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3500
  • Fax: 314-768-6621
Mailing address:
  • Phone: 618-795-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2023012162
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57.248173
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2023012162
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: