Healthcare Provider Details

I. General information

NPI: 1316887342
Provider Name (Legal Business Name): EGLE MIKONE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 S GRAND BLVD
ST LOUIS MO
63104
US

IV. Provider business mailing address

690 TRAILCREST
KIRKWOOD MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2777
  • Fax:
Mailing address:
  • Phone: 917-982-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: