Healthcare Provider Details

I. General information

NPI: 1285284950
Provider Name (Legal Business Name): RYAN MICHAEL TEGETHOFF PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DEPT ORTHOPAEDIC SURGERY
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2551
  • Fax: 314-747-2598
Mailing address:
  • Phone: 314-747-2551
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2019041545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: