Healthcare Provider Details

I. General information

NPI: 1083727366
Provider Name (Legal Business Name): SANJEEV M LELE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 120
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

4530 HAMPTON AVE
SAINT LOUIS MO
63109-2238
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-0101
  • Fax: 314-849-3025
Mailing address:
  • Phone: 314-352-9800
  • Fax: 314-352-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number102794
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: