Organization
MICHAEL CANNON, MD PERSONALIZED MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CANNON (OWNER/ MD)
(314) 574-2851
Entity
Organization
Contact information
Practice address
16216 BAXTER RD STE 340, CHESTERFIELD, MO 63017-4778
(314) 325-8925
Mailing address
PO BOX 221240, KIRKWOOD, MO 63122-8240
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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