Boedefeld, Michael Scott

Boedefeld, Michael Scott is an individual health care provider with primary practice located at 1055 Bowles Ave Ste 202 , Fenton MO 63026-2308. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Boedefeld, Michael Scott can be contacted via phone (636) 386-7222.

Contact Information

Primary practice address
1055 Bowles Ave Ste 202 Fenton MO 63026-2308
Phone: (636) 386-7222
Fax: (636) 386-7810
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 2004009978 Missouri
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 2004009978 Missouri

Profile Details

NPI number 1043299548
LBN Legal business name Boedefeld, Michael Scott
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2006
Last updated Oct 20th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043299548 NPPES
Missouri MEDICAID 207320102

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