Healthcare Provider Details

I. General information

NPI: 1295175677
Provider Name (Legal Business Name): AGNIESZKA MILCZAREK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE WASHINGTON UNIVERSITY, DEPT. OF PSYCHIATRY, BOX 8134
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE WASHINGTON UNIVERSITY, DEPT. OF PSYCHIATRY, BOX 8134
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-2462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2013017016
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: