Provider Demographics
NPI:1235317348
Name:MICHAEL G VRANICH DO PC
Entity Type:Organization
Organization Name:MICHAEL G VRANICH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:VRANICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-291-6224
Mailing Address - Street 1:3444 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2525
Mailing Address - Country:US
Mailing Address - Phone:314-291-6224
Mailing Address - Fax:314-291-7346
Practice Address - Street 1:3444 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2525
Practice Address - Country:US
Practice Address - Phone:314-291-6224
Practice Address - Fax:314-291-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6314208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241037217Medicaid
1700862653OtherINDIVIDUAL NPI
MO000014191Medicare PIN
D41722Medicare UPIN