MEDICARE: DR. MICHAEL THEODORE KATSEV DDS

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	122300000X	Dentist	14628	MO

General Provider Information

NPI Number	:	1447334875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THEODORE KATSEV DDS

Provider Business Mailing Address
First Line	:	3478 BRIDGELAND DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2619
Country	:	US
Telephone Number	:	314-291-2573
Fax Number	:

Provider Business Practice Location Address
First Line	:	3478 BRIDGELAND DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2619
Country	:	US
Telephone Number	:	314-291-2573
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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