MEDICARE: MS. GRACE VAVRIK PA

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	363A00000X	Physician Assistant	2026008852	MO

General Provider Information

NPI Number	:	1871442996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACE VAVRIK PA

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-362-3577
Fax Number	:	314-362-2107

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:	DEPT NEUROLOGICAL SURGERY
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6163
Country	:	US
Telephone Number	:	314-362-3577
Fax Number	:	314-362-2107

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	04/17/2026

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