Healthcare Provider Details

I. General information

NPI: 1144647355
Provider Name (Legal Business Name): MARY KATHRYN MALECEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHRYN DUNCAN MD

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5151
  • Fax:
Mailing address:
  • Phone: 314-362-1700
  • Fax: 314-362-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2017010068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: