Individual
MICHAEL T JEDLINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3250 GORDONVILLE RD STE 301, CAPE GIRARDEAU, MO 63703-5095
(573) 334-9641
(573) 331-4130
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-5583
(573) 331-5079
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R5H98
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178522
HEALTHLINK
—
05
—
1962421750
—
IL
05
—
202544607
—
MO
01
—
603532
ANTHEM BCBS
MO
01
—
P00779923
RR MCR
MO
Enumeration date
07/19/2006
Last updated
03/01/2021
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