Provider Demographics
NPI:1730410333
Name:WERNER, MICHAEL D (BOCO)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:WERNER
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KEN DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4412
Mailing Address - Country:US
Mailing Address - Phone:314-630-9888
Mailing Address - Fax:636-326-4242
Practice Address - Street 1:8 KEN DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4412
Practice Address - Country:US
Practice Address - Phone:314-630-9888
Practice Address - Fax:636-326-4242
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC26296OtherBOARD OF CERTIFICATION / ACCREDITATION, INTERNATIONAL