Provider Demographics
NPI:1447575964
Name:REIDY, MICHAEL RYAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:REIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD STE 550N
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3641
Mailing Address - Country:US
Mailing Address - Phone:314-434-3049
Mailing Address - Fax:314-590-5939
Practice Address - Street 1:222 S WOODS MILL RD STE 550N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3641
Practice Address - Country:US
Practice Address - Phone:314-434-3049
Practice Address - Fax:314-590-5939
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018005681208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)