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Individual

MR. MICHAEL CONRAD BERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RCP, RN

Contact information

Practice address
3933 SOUTH BROADWAY, ST. LOUIS, MO 63118-4626
(314) 865-7034
(314) 865-7018
Mailing address
7142 CIRCLEVIEW DR., ST. LOUIS, MO 63123-1604
(314) 452-2115

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041494547
IL
163W00000X
Registered Nurse
2004004424
MO
2279G1100X
General Care Registered Respiratory Therapist
Primary
100275
MO

Other

Enumeration date
10/24/2022
Last updated
10/24/2022
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