Individual
MICHAEL FEDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13303 TESSON FERRY RD, SUITE 150, SAINT LOUIS, MO 63128-4062
(314) 842-4744
(314) 842-3835
Mailing address
PO BOX 419052, SAINT LOUIS, MO 63141-9052
(314) 851-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36371
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010015
ESSENCE
MO
01
—
0400399
UHC
MO
01
—
100609
HEALTHLINK
MO
01
—
127478
GHP
MO
01
—
25552
BCBS
MO
01
—
A29062
MERCY
MO
Enumeration date
11/04/2005
Last updated
01/06/2025
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