Healthcare Provider Details

I. General information

NPI: 1356252142
Provider Name (Legal Business Name): MEGAN MADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 QUEENS CT
SAINT PETERS MO
63376-7375
US

IV. Provider business mailing address

133 ESTES DR
SAINT CHARLES MO
63304-5502
US

V. Phone/Fax

Practice location:
  • Phone: 636-793-0650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF09260517
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: