Basic Information
| Provider Information | |||||||||
| NPI: | 1992800429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEZEI | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 139 N CENTRAL AVE APT D | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631053800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144861396 | ||||||||
| FaxNumber: | 3144853520 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 N CENTRAL AVE APT D | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631053800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144861396 | ||||||||
| FaxNumber: | 3144853520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | R3E74 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 125578 | 01 | MO | GROUP HEALTH PLAN | OTHER | A13364 | 01 | MO | MERCY HEALTH PLAN | OTHER | 161200 | 01 | MO | BLUE SHIELD | OTHER | 202528048 | 05 | MO | MEDICAID | 4061166 | 01 | MO | AETNA | OTHER | STL2500039 | 01 | MO | UNITED HEALTHCARE | OTHER | 060069533 | 01 | MO | RAILROAD MEDICARE | OTHER | 161200 | 01 | MO | BLUE CHOICE | OTHER | STM2500039 | 01 | MO | UHC MEDICARE COMPLETE | OTHER | 254499 | 01 | MO | HEALTHLINK | OTHER |