Provider Demographics
NPI:1477926624
Name:PENKOSKE, MICHAELE MARY (M D)
Entity Type:Individual
Prefix:DR
First Name:MICHAELE
Middle Name:MARY
Last Name:PENKOSKE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4524
Mailing Address - Country:US
Mailing Address - Phone:314-397-6244
Mailing Address - Fax:
Practice Address - Street 1:24 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4524
Practice Address - Country:US
Practice Address - Phone:314-397-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine