Provider Demographics
NPI:1134194863
Name:BELLAMY, MICHELE T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:T
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12680 OLIVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6322
Mailing Address - Country:US
Mailing Address - Phone:314-251-8900
Mailing Address - Fax:314-251-8901
Practice Address - Street 1:12680 OLIVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-8900
Practice Address - Fax:314-251-8901
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000168814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH61249Medicare UPIN