Provider Demographics
NPI:1467427161
Name:PADRATZIK, JAY L (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:PADRATZIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 4017-B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-872-9192
Mailing Address - Fax:314-995-4234
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 4017-B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-872-9192
Practice Address - Fax:314-995-4234
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1467427161Medicaid
MO160052306OtherRAILROAD MEDICARE
MO160049273OtherRAILROAD MEDICARE
MO1467427161Medicaid
MO160052306OtherRAILROAD MEDICARE
MOMA4412010Medicare PIN
MO160049273OtherRAILROAD MEDICARE