MEDICARE: DANIEL HAFENRICHTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	103467	MO

General Provider Information

NPI Number	:	1063483139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL HAFENRICHTER MD

Provider Business Mailing Address
First Line	:	3009 N BALLAS RD STE 320A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-7882
Fax Number	:	314-569-7135

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD STE 320A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-7882
Fax Number	:	314-569-7135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	10/03/2023

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