Healthcare Provider Details

I. General information

NPI: 1689965451
Provider Name (Legal Business Name): MATTHEW PAUL KLICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 STUDT AVE
SAINT LOUIS MO
63141-7480
US

IV. Provider business mailing address

1061 HARMON AVE
FORT STEWART GA
31314-5674
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-9199
  • Fax: 314-989-9491
Mailing address:
  • Phone: 912-435-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2019030495
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2019030495
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: