Healthcare Provider Details

I. General information

NPI: 1023010998
Provider Name (Legal Business Name): JINA LEE MCATEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JINA AGNES LEE MD

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/18/2022
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

IV. Provider business mailing address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-5190
  • Fax: 314-353-1310
Mailing address:
  • Phone: 314-353-5190
  • Fax: 314-353-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number108135
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: