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General NPI Number Information
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NPI Number | 1689965451
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Entity Type | Individual
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Provider Name | MATTHEW PAUL KLICK D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 11700 STUDT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7480
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Country | US
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Telephone | 314-989-9199
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Fax | 314-989-9491
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Provider Business Mailing Address
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Address Line | 1061 HARMON AVE
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City | FORT STEWART
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State | GA
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Zip | 31314-5674
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Country | US
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Telephone | 912-435-6965
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 2019030495
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 2019030495
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License Number State | MO
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