Healthcare Provider Details

I. General information

NPI: 1124551403
Provider Name (Legal Business Name): MATTHEW FRANCIS BIALKO M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 06/09/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117
US

IV. Provider business mailing address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-4772
  • Fax: 314-645-8771
Mailing address:
  • Phone: 314-781-4772
  • Fax: 314-645-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018017661
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: