MEDICARE: MICHELLE RENEE PETRICH 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	207VM0101X	Maternal & Fetal Medicine Physician	2023012162	MO
2	207V00000X	Obstetrics & Gynecology Physician	57.248173	OH
3	207V00000X	Obstetrics & Gynecology Physician	2023012162	MO

General Provider Information

NPI Number	:	1447814702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE PETRICH MD

Provider Business Mailing Address
First Line	:	505 FAIRWOOD HILLS RD
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-3562
Country	:	US
Telephone Number	:	618-795-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1997
Country	:	US
Telephone Number	:	314-617-3500
Fax Number	:	314-768-6621

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

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/07/2026

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