MEDICARE: DR. MICHAEL R CRIST D.O.

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	207Q00000X	Family Medicine Physician	R4A27	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	010066246	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111986	OTHER	MO	BLUE CROSS BLUE SHIELD MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	108161	OTHER	MO	HEALTHLINK
5	1663	OTHER	MO	HEALTHCARE USA

General Provider Information

NPI Number	:	1548240054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R CRIST D.O.

Provider Business Mailing Address
First Line	:	814 FAIRLANE DR
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2318
Country	:	US
Telephone Number	:	660-258-3397
Fax Number	:	660-258-3945

Provider Business Practice Location Address
First Line	:	814 FAIRLANE DR
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2318
Country	:	US
Telephone Number	:	660-258-3397
Fax Number	:	660-258-3945

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/14/2017

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Directions to “ DR. MICHAEL R CRIST D.O.” Practice Location

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