Provider Demographics
NPI:1972508927
Name:CHERAZARD, MICHEL RENAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:RENAUD
Last Name:CHERAZARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 WINDY ACRES ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4230
Mailing Address - Country:US
Mailing Address - Phone:636-207-7088
Mailing Address - Fax:
Practice Address - Street 1:10 ADAMS ST
Practice Address - Street 2:STE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2751
Practice Address - Country:US
Practice Address - Phone:314-306-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO357982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201157138Medicaid
MO000009013Medicare ID - Type Unspecified
MO201157138Medicaid