Provider Demographics
NPI:1134118482
Name:LEE, STEVEN F (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:#5006B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-432-5478
Mailing Address - Fax:314-569-0864
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:#5006B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-432-5478
Practice Address - Fax:314-569-0864
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108687207W00000X
IL036099328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21577OtherBCBS
MO273460OtherHEALTHLINK
MO208033910Medicaid
ILK12557OtherMEDICARE ILLINOIS
MO1134118482Medicaid
MO273460OtherHEALTHLINK
MO145450007Medicare PIN
MO208033910Medicaid
ILK12557OtherMEDICARE ILLINOIS