DR. TERENCE MICHAEL MYCKATYN (NPI# 1598781718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598781718 |
| Entity Type | Individual |
| Full Name | DR. TERENCE MICHAEL MYCKATYN |
| Credential | MD |
| Practice Address |
1020 N Mason Rd Bldg 3 Ste 110 Saint Louis MO 63141-6666 |
| Mailing Address |
660 S Euclid Ave Cb 8238 Saint Louis MO 63110-1010 |
| Practice Telephone | 3149968800 |
| Practice Fax Number | 3149963030 |
| Mailing Telephone | 3144544894 |
| Mailing Fax Number | 3147474871 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
2000173749 | MO | Allopathic & Osteopathic Physicians |
| N | 2086S0105X |
Surgery Specialization: Surgery of the Hand |
2000173749 | MO | Allopathic & Osteopathic Physicians |
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
2000173749 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 207820606 | 05 | |
| IL | ENROLLED | 05 |
| Street Address |
1020 N MASON RD BLDG 3 STE 110 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-6666 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225020712 | Lynne M Seacord | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2005-08-19 |
| 1427390160 | Christopher John Rizzi | Otolaryngology | 1020 N Mason Rd, Ste 205, Saint Louis, MO 63141-6666 | 2013-03-20 |
| 1750645503 | Emily Anne Spataro | Otolaryngology | 1020 N Mason Rd, Ste 205, Saint Louis, MO 63141-6666 | 2012-06-26 |
| 1194743872 | Roberto Civitelli | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-07-18 |
| 1174540611 | Richard G Bach | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-07-17 |
| 1982622478 | Robert Arthur Shively | Orthopaedic Surgery | 1020 N Mason Rd, Ste 110 Building 3, Saint Louis, MO 63141-6300 | 2006-07-17 |
| 1265476683 | Alan N Weiss | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-06-15 |
| 1982648317 | John M Lasala | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-06-15 |
| 1437193877 | Scott Monroe Nordlicht | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-06-15 |
| 1356383624 | Attila Kovacs | Internal Medicine | 1020 N Mason Rd, Saint Louis, MO 63141-6300 | 2006-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073676755 | Parkcrest Plastic Surgery, Inc. | Surgery | 845 N. New Ballas Court, Suite 300, Saint Louis, MO 63141-7083 | 2006-12-18 |
| 1164536710 | Brock Davis Ridenour | Surgery | 12460 Olive Blvd, Suite 202, Saint Louis, MO 63141-6409 | 2006-08-19 |
| 1255332904 | Charles David Ettelson | Surgery | 730 Audubon Dr, Saint Louis, MO 63105-2906 | 2005-08-03 |
| 1962063222 | William Young Zhu | Surgery | 1 Barnes Jew Hosp Plz, Saint Louis, MO 63110-1003 | 2019-06-26 |
| 1619498821 | Lauren Anne Jacobson | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2017-06-28 |
| 1649685660 | Elspeth Jane Rose Hill | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2014-06-28 |
| 1396092714 | Rajiv Parikh | Surgery | 660 S Euclid Ave, Suite 1150 Northwest Tower, Campus Box 8238, Saint Louis, MO 63110-1010 | 2012-08-06 |
| 1316258106 | Olivier Deigni | Surgery | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2010-06-25 |
| 1649407370 | Scott Jeremy Farber | Surgery | 660 S Euclid Ave # 8109, Department of Surgery, Saint Louis, MO 63110-1010 | 2009-06-20 |
| 1861662272 | Patricia A Mcguire | Surgery | 845 N New Ballas Ct, Suite 300, Saint Louis, MO 63141-7134 | 2008-03-03 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.