Provider Demographics
NPI:1528462272
Name:PYATEK, KATHLEEN MARIE (PA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:PYATEK
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-747-7111
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM GASTROENTEROLOGY, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-747-7111
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023018149363A00000X
IDPA1191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220132587Medicaid