Healthcare Provider Details

I. General information

NPI: 1326740291
Provider Name (Legal Business Name): MICHAEL JAMES PADGETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4227 MCPHERSON AVE
SAINT LOUIS MO
63108-2907
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2024022223
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: