Individual
DR. TERENCE MICHAEL MYCKATYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 N MASON RD, DIV SURG PLASTICS, MOB 3 STE 110, SAINT LOUIS, MO 63141-6666
(314) 362-7388
(833) 301-0853
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-7388
(833) 301-0853
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
2000173749
MO
2086S0105X
Surgery of the Hand (Surgery) Physician
2000173749
MO
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
2000173749
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207820606
—
MO
Enumeration date
07/14/2006
Last updated
04/17/2025
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