Provider Demographics
NPI:1023061926
Name:RAILEY, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:RAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6125 CLAYTON AVE
Mailing Address - Street 2:STE 222
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3265
Mailing Address - Country:US
Mailing Address - Phone:314-768-3204
Mailing Address - Fax:314-768-3940
Practice Address - Street 1:6125 CLAYTON AVE
Practice Address - Street 2:STE 222
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3265
Practice Address - Country:US
Practice Address - Phone:314-768-3685
Practice Address - Fax:314-768-3940
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201072873Medicaid
B18374Medicare UPIN
MO201072873Medicaid