Provider Demographics
NPI:1780015701
Name:PLISKE, MATTHEW ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:PLISKE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:350 HERITAGE COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 PIPER HILL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-441-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant