Healthcare Provider Details

I. General information

NPI: 1912970880
Provider Name (Legal Business Name): VLADIMIR MELYAKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

12125 WOODCREST EXECUTIVE DR SUITE 220
SAINT LOUIS MO
63141-5001
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-1020
  • Fax:
Mailing address:
  • Phone: 314-317-0600
  • Fax: 314-317-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004030339
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2004030339
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0061945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: