Healthcare Provider Details

I. General information

NPI: 1366381543
Provider Name (Legal Business Name): JONAH DANIEL JERABEK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD RM M260
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

11320 PARKSIDE TRL
MAPLE GROVE MN
55369-9422
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2359
  • Fax:
Mailing address:
  • Phone: 612-267-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: