Individual
GEORGE M. MATUSCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 228A, SAINT LOUIS, MO 63141-8232
(314) 251-4966
(314) 251-4588
Mailing address
621 S NEW BALLAS RD, SUITE 228A, SAINT LOUIS, MO 63141-8232
(314) 251-4966
(314) 251-4588
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
R3H17
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881780021
—
MO
05
—
19440524
—
IL
05
—
202469409
—
MO
01
—
P01021649
RAILROAD MEDICARE
MO
Enumeration date
10/05/2006
Last updated
08/28/2014
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