Healthcare Provider Details

I. General information

NPI: 1083617294
Provider Name (Legal Business Name): MORIN MICHAEL HANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 402
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN RD STE 402
SAINT LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-3400
  • Fax: 314-741-4357
Mailing address:
  • Phone: 314-741-3400
  • Fax: 314-741-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number105535
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: