Healthcare Provider Details

I. General information

NPI: 1770151011
Provider Name (Legal Business Name): CAMILO ANDRES MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N MASON RD STE 145B
SAINT LOUIS MO
63141-6282
US

IV. Provider business mailing address

969 N MASON RD STE 145B
SAINT LOUIS MO
63141-6282
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-3700
  • Fax: 314-434-5708
Mailing address:
  • Phone: 314-878-3700
  • Fax: 314-434-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024038740
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: