Provider Demographics
NPI:1699148429
Name:FARRELL, MICHAEL EDWIN (CSA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWIN
Last Name:FARRELL
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2425 SANSONNET LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3597
Mailing Address - Country:US
Mailing Address - Phone:501-658-6186
Mailing Address - Fax:
Practice Address - Street 1:2425 SANSONNET LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3597
Practice Address - Country:US
Practice Address - Phone:501-658-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical