Provider Demographics
NPI:1427779222
Name:TODD, MICHAELA ANNE (PA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ANNE
Last Name:TODD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:ANNE
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-372-3420
Mailing Address - Fax:314-372-3415
Practice Address - Street 1:9180 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1421
Practice Address - Country:US
Practice Address - Phone:314-372-3420
Practice Address - Fax:314-372-3415
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023042640363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program