Provider Demographics
NPI:1730297862
Name:RALPH, MICHAEL HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:RALPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 66980
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6980
Mailing Address - Country:US
Mailing Address - Phone:314-669-7070
Mailing Address - Fax:314-577-5726
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-669-7070
Practice Address - Fax:314-577-5726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4C91207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201725439Medicaid
A11100Medicare UPIN
MO0188110001Medicare NSC