Healthcare Provider Details

I. General information

NPI: 1184328122
Provider Name (Legal Business Name): LILLIAN KATE WHALEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 530
RICHMOND HEIGHTS MO
63117-1271
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD STE 530
RICHMOND HEIGHTS MO
63117-1271
US

V. Phone/Fax

Practice location:
  • Phone: 314-798-7422
  • Fax:
Mailing address:
  • Phone: 314-798-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026019196
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8477120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: