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General NPI Number Information
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NPI Number | 1033783717
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Entity Type | Individual
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Provider Name | JOSHUA HARKLESS MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 100 MEDICAL PLZ
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-625-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-6686
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Country | US
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Telephone | 773-702-1150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2024013461
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License Number State | MO
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