Healthcare Provider Details

I. General information

NPI: 1518417708
Provider Name (Legal Business Name): MD AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 HIGHWAY N
COTTLEVILLE MO
63304-8032
US

IV. Provider business mailing address

5377 HIGHWAY N
COTTLEVILLE MO
63304-8032
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-2172
  • Fax:
Mailing address:
  • Phone: 314-401-6210
  • Fax: 314-754-9564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005023728
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW JOHN GIBFRIED
Title or Position: OWNER
Credential: M.D.
Phone: 314-401-6210