MEDICARE: DR. KENNETH ALSTON LEE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2020019424	MO

General Provider Information

NPI Number	:	1063040574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ALSTON LEE DO

Provider Business Mailing Address
First Line	:	4660 SOUTH LINDBERGH
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127
Country	:	US
Telephone Number	:	314-843-7557
Fax Number	:	314-849-8671

Provider Business Practice Location Address
First Line	:	4460 S LINDBERGH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1647
Country	:	US
Telephone Number	:	573-359-4485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	07/24/2023

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