Provider Demographics
NPI:1124288352
Name:GREGORY R GALAKATOS MD LLC
Entity type:Organization
Organization Name:GREGORY R GALAKATOS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALAKATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-567-5850
Mailing Address - Street 1:POST OFFICE BOX 50308
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 5015-B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-567-5850
Practice Address - Fax:314-395-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110323207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106554OtherBLUE CROSS/BLUE SHIELD
MO293165OtherHEALTHLINK
MO0900351OtherUNITED HEALTH CARE
MO5243149OtherAETNA
MO106554OtherBLUE CROSS/BLUE SHIELD
000015109Medicare UPIN