Healthcare Provider Details

I. General information

NPI: 1205825031
Provider Name (Legal Business Name): RICHARD W MAACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD SUITE 37 WEST
CHESTERFIELD MO
63017-3662
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 37W
CHESTERFIELD MO
63017-3442
US

V. Phone/Fax

Practice location:
  • Phone: 314-523-5300
  • Fax: 314-434-3191
Mailing address:
  • Phone: 314-523-5300
  • Fax: 314-434-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD R2G99
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD R2G99
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: