Healthcare Provider Details

I. General information

NPI: 1548286776
Provider Name (Legal Business Name): DONGSI LU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1026
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8118
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5641
  • Fax: 314-362-0369
Mailing address:
  • Phone: 314-362-5641
  • Fax: 314-362-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2004009701
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2004009701
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: