Healthcare Provider Details

I. General information

NPI: 1205419223
Provider Name (Legal Business Name): MICHELLE AUDREY DARMADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/14/2026
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE DIV PED HOSPITALIST MED
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7728
  • Fax: 417-269-7729
Mailing address:
  • Phone: 417-269-7728
  • Fax: 417-269-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025006828
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025006828
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: