Provider Demographics
NPI:1770572067
Name:DONAHOE, MICHAEL PHILIP (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILIP
Last Name:DONAHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12990 MANCHESTER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1860
Mailing Address - Country:US
Mailing Address - Phone:314-909-0633
Mailing Address - Fax:314-909-0391
Practice Address - Street 1:12990 MANCHESTER RD STE 201
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1860
Practice Address - Country:US
Practice Address - Phone:314-909-0633
Practice Address - Fax:314-909-0391
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102870207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14740OtherBCBS
MO203747001Medicaid
MO207630OtherHEALTHLINK
MO1775072067Medicaid
F70759Medicare UPIN
MO203747001Medicaid
MO145450005Medicare PIN
MO1775072067Medicaid