Healthcare Provider Details

I. General information

NPI: 1215557665
Provider Name (Legal Business Name): MATTHEW THOMAS BENJAMIN SKALAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 10/27/2025
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV SURG UROLOGY PED
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6034
  • Fax: 314-454-2876
Mailing address:
  • Phone: 314-454-6034
  • Fax: 314-454-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2025012429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: