Healthcare Provider Details

I. General information

NPI: 1043312705
Provider Name (Legal Business Name): MARK C MURAWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 N NEW BALLAS RD STE 304
SAINT LOUIS MO
63141-6831
US

IV. Provider business mailing address

PO BOX 7412065
CHICAGO IL
60674-2065
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-6868
  • Fax: 314-567-0578
Mailing address:
  • Phone: 314-567-6868
  • Fax: 314-567-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2002002094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: