Healthcare Provider Details

I. General information

NPI: 1720509557
Provider Name (Legal Business Name): AYSE ECE CALI DAYLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2017
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV IM MEDICAL ONCOLOGY, 7TH FL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-1171
  • Fax: 314-362-7086
Mailing address:
  • Phone: 314-747-1171
  • Fax: 314-362-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2023049394
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023049394
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number2023049394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: