=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407964281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE LEE COGAN-LEVY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 04/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12277 DE PAUL DR STE 501S
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-739-8844
-----------------------------------------------------
Fax | 314-739-5431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 S WOODS MILL RD STE 510S
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-434-6130
-----------------------------------------------------
Fax | 314-434-1277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 2005038614
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------