Provider Demographics
NPI:1700862653
Name:VRANICH, MICHAEL GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:VRANICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11255 LADUE RD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8318
Mailing Address - Country:US
Mailing Address - Phone:314-614-5368
Mailing Address - Fax:941-254-7497
Practice Address - Street 1:11255 LADUE RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8318
Practice Address - Country:US
Practice Address - Phone:314-614-5368
Practice Address - Fax:941-254-7497
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6314208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241037217Medicaid