Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2003013331 | MO |
NPI | 1003952458 |
---|---|
Provider Name | Eldad Shaul Bialecki |
First Address | Saint Louis, MO 63156-3340 |
Second Address | Hazelwood, MO 63042-1820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 13/02/2017 |