Individual
HOWARD JAY ILIVICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 1ST CAPITOL DR, STE 390, SAINT CHARLES, MO 63301-2852
(636) 949-5760
(636) 949-0729
Mailing address
4132 KEATON CROSSING BLVD, STE 201, O FALLON, MO 63368-8222
(636) 244-3589
(636) 244-3594
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
118786
MO
2084P0800X
Psychiatry Physician
Primary
MD61660624
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122112
BLUE CROSS BLUE SHIELD
—
01
—
415921
HEALTHLINK
—
Enumeration date
06/23/2005
Last updated
04/08/2025
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