Healthcare Provider Details

I. General information

NPI: 1902294648
Provider Name (Legal Business Name): SEOUNG EUN RHEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 AMERSHAM DR.
ST. LOUIS MO
63141-8828
US

IV. Provider business mailing address

883 AMERSHAM DR.
ST. LOUIS MO
63141-8828
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2789
  • Fax: 314-569-2789
Mailing address:
  • Phone: 314-569-2789
  • Fax: 314-569-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: