Healthcare Provider Details

I. General information

NPI: 1578792297
Provider Name (Legal Business Name): MELISSA ROEWE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9979 WINGHAVEN BLVD STE 206
O FALLON MO
63368
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5291
  • Fax: 636-561-5290
Mailing address:
  • Phone: 314-851-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2015029679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: