Provider Demographics
NPI:1831180025
Name:DANTER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DANTER
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:636-561-5291
Mailing Address - Fax:636-561-5290
Practice Address - Street 1:9979 WINGHAVEN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3627
Practice Address - Country:US
Practice Address - Phone:636-561-5291
Practice Address - Fax:636-561-5290
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6J55208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4259417OtherAETNA
MO132482OtherHEALTHLINK
100375OtherBCBS
MO1200099OtherUHC FLORISSANT
MO1200683OtherUHC
MO188961OtherGHP
MO1200683OtherUHC