Healthcare Provider Details

I. General information

NPI: 1356918932
Provider Name (Legal Business Name): MAKENNA ARCA PARADOWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

1 CHILDRENS PL STE 3S34
SAINT LOUIS MO
63110-1081
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021018033
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberV4168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: