Healthcare Provider Details

I. General information

NPI: 1912069592
Provider Name (Legal Business Name): KI LEE MILLIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KI LEE M.D.

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01057284A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTEMPORARY
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: