MEDICARE: MICHAELA ANNE TODD PA

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	363A00000X	Physician Assistant	2023042640	MO
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1427779222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA ANNE TODD PA

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:	314-372-3415

Provider Business Practice Location Address
First Line	:	9180 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1421
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:	314-372-3415

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	10/22/2025

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