Provider Demographics
NPI:1831139609
Name:BIERNACKI, MAJ-BETH (MD)
Entity Type:Individual
Prefix:
First Name:MAJ-BETH
Middle Name:
Last Name:BIERNACKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAJ-BETH
Other - Middle Name:
Other - Last Name:RULIFSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11475 OLDE CABIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7129
Mailing Address - Country:US
Mailing Address - Phone:314-991-8210
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6031
Practice Address - Fax:314-251-6343
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361228602085R0202X
NJ25MA077555002085R0202X
FLME1241692085R0202X
KS04317622085R0202X
MO20060116452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130667Medicare PIN
OK246624201Medicare PIN
MOK67000001Medicare PIN
KSP00614564Medicare PIN
MOP00628920Medicare PIN
MO132680394Medicare PIN
KSP00415216Medicare PIN
MO0560A0001Medicare PIN
MO500410053Medicare PIN
MOI56639Medicare UPIN
MO05600002BMedicare PIN
OKP00332087Medicare PIN
KSK67F794AMedicare PIN
AR196561001Medicaid
KS200390220BMedicaid
KSP00614564OtherRR MEDICARE
KS200390220AMedicaid
MO0560A0001Medicare PIN
MO500410053Medicare PIN
MOI56639Medicare UPIN
OK200087950AMedicaid
OKP00332087Medicare PIN
MO05600002BMedicare PIN
KSK67F794AMedicare PIN