Provider Demographics
NPI:1154609733
Name:PHALAK, JUEE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JUEE
Middle Name:
Last Name:PHALAK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63188-0551
Mailing Address - Country:US
Mailing Address - Phone:314-898-1700
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:1717 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3454
Practice Address - Country:US
Practice Address - Phone:314-898-1700
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20110159482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015031295OtherLICENSE