Healthcare Provider Details

I. General information

NPI: 1508995150
Provider Name (Legal Business Name): MICHAEL LEONARD WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

901 PATIENTS FIRST DR
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-2711
  • Fax: 636-239-3385
Mailing address:
  • Phone: 636-239-2711
  • Fax: 636-239-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number17458
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2007001655
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2007001655
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: