Provider Demographics
NPI:1609867142
Name:BARKOVIAK, MICHAEL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:BARKOVIAK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:SUITE 2335
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-5007
Mailing Address - Fax:314-653-4149
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:SUITE 2335
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-653-5007
Practice Address - Fax:314-653-4149
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO118286207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK08850Medicare PIN
MOE59892Medicare UPIN
ILK08913Medicare PIN