MEDICARE: DR. THOMAS JOHN GNIADEK MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	036145372	IL
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036145372	IL
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2024018547	MO
4	207ZB0001X	Blood Banking & Transfusion Medicine Physician	2024018547	MO

General Provider Information

NPI Number	:	1205101334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOHN GNIADEK MD PHD

Provider Business Mailing Address
First Line	:	844 KNOLLWOOD RD
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-3313
Country	:	US
Telephone Number	:	203-806-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1004
Country	:	US
Telephone Number	:	314-617-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	01/07/2026

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