=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477673432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHELE C. WOODLEY, M.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3009 N BALLAS RD SUITE 350C
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-5044
-----------------------------------------------------
Fax | 314-432-2521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3009 N BALLAS RD SUITE 350C
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-5044
-----------------------------------------------------
Fax | 314-432-2521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHELE CATHERINE WOODLEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 314-432-5044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------