Individual
MADISON ALICE MIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
621 S NEW BALLAS RD STE 189A, SAINT LOUIS, MO 63141-8255
(314) 251-6335
(314) 251-5864
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 251-6335
(314) 251-5864
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2023040354
MO
Other
Enumeration date
01/04/2022
Last updated
01/16/2025
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