MEDICARE: ELIZABETH H MAYLACK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036140361	IL
2	207Q00000X	Family Medicine Physician	2018020904	MO

General Provider Information

NPI Number	:	1154687077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH H MAYLACK D.O.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	314-851-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 WALL ST STE 400
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3541
Country	:	US
Telephone Number	:	636-669-7006
Fax Number	:	636-669-7008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	03/31/2020

Similar Medicare Providers

1225331432 — REGINA DAMPIER
Practice Location Address:

1551 WALL ST STE 300
SAINT CHARLES, MO
63303-3541

Practice Phone: 888-777-1945
Practice Fax:

1972923126 — RAFI FREDMAN MD
Practice Location Address:

1551 WALL ST STE 420
SAINT CHARLES, MO
63303-3541

Practice Phone: 636-329-4036
Practice Fax: 636-206-2898

1205218344 — AMY THERESA MCCORY ANP
Practice Location Address:

1551 WALL ST STE 400
SAINT CHARLES, MO
63303-3541

Practice Phone: 636-669-7006
Practice Fax: 636-669-7008

1912356312 — DR. ALAN TOM M.D.
Practice Location Address:

1551 WALL ST STE 420
SAINT CHARLES, MO
63303-3541

Practice Phone: 636-329-4036
Practice Fax:

1215563374 — RAFI FREDMAN MD LLC
Practice Location Address:

1551 WALL ST STE 420
SAINT CHARLES, MO
63303-3541

Practice Phone: 636-329-4036
Practice Fax:

1104342708 — WALGREEN CO
Practice Location Address:

7133 SAINT CHARLES AVE
NEW ORLEANS, LA
70118-3541

Practice Phone: 504-861-3638
Practice Fax:

Directions to “ ELIZABETH H MAYLACK D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.