Healthcare Provider Details

I. General information

NPI: 1205101334
Provider Name (Legal Business Name): THOMAS JOHN GNIADEK MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

844 KNOLLWOOD RD
DEERFIELD IL
60015-3313
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2000
  • Fax:
Mailing address:
  • Phone: 203-806-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number036145372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036145372
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2024018547
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number2024018547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: