# MICHAEL CANNON, MD PERSONALIZED MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326769175
- **Authorized official:** MICHAEL CANNON (OWNER/ MD)
- **Authorized official phone:** (314) 574-2851

## Contact information

- **Practice address:** 16216 BAXTER RD STE 340, CHESTERFIELD, MO 63017-4778
- **Practice address phone:** (314) 325-8925
- **Mailing address:** PO BOX 221240, KIRKWOOD, MO 63122-8240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2022
- **Last updated:** 09/09/2022