Healthcare Provider Details

I. General information

NPI: 1093165946
Provider Name (Legal Business Name): CATHERINE ANN VASILEVSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD STE 6017B
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD STE 6017B
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7840
  • Fax: 314-251-4173
Mailing address:
  • Phone: 314-251-7840
  • Fax: 314-251-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2016020817
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: