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NPI Code Detail

MEDICARE: DR. TERENCE MICHAEL MYCKATYN MD

MEDICARE: DR. TERENCE MICHAEL MYCKATYN MD
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
12082S0099XPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician2000173749MO
22086S0105XSurgery of the Hand (Surgery) Physician2000173749MO
32086S0122XPlastic and Reconstructive Surgery Physician2000173749MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598781718
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERENCE MICHAEL MYCKATYN MD
Provider Business Mailing Address
First Line : PO BOX 7412011
Second Line :
City : CHICAGO
State : IL
Zip : 60674-2011
Country : US
Telephone Number : 314-362-7388
Fax Number : 833-301-0853
Provider Business Practice Location Address
First Line : 1020 N MASON RD
Second Line : DIV SURG PLASTICS, MOB 3 STE 110
City : SAINT LOUIS
State : MO
Zip : 63141-6666
Country : US
Telephone Number : 314-362-7388
Fax Number : 833-301-0853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 04/17/2025

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Directions to “ DR. TERENCE MICHAEL MYCKATYN MD” Practice Location

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