Healthcare Provider Details

I. General information

NPI: 1699718692
Provider Name (Legal Business Name): LAURA PULASKI BARTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA PULASKI HILL M.D.

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEMORIAL DR. STE 110
ALTON IL
62002
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-1711
  • Fax: 618-474-1711
Mailing address:
  • Phone: 618-433-6570
  • Fax: 618-433-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2004035767
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036115152
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2004035767
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: