Healthcare Provider Details

I. General information

NPI: 1922453760
Provider Name (Legal Business Name): JOE SHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 499A
SAINT LOUIS MO
63141-8260
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 499A
SAINT LOUIS MO
63141-8260
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7650
  • Fax:
Mailing address:
  • Phone: 314-251-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2024010642
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number282440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: