Provider Demographics
NPI:1992800429
Name:MEZEI, LESLIE E (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:MEZEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N CENTRAL AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3800
Mailing Address - Country:US
Mailing Address - Phone:314-486-1396
Mailing Address - Fax:314-485-3520
Practice Address - Street 1:139 N CENTRAL AVE APT D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3800
Practice Address - Country:US
Practice Address - Phone:314-486-1396
Practice Address - Fax:314-485-3520
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3E74207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO125578OtherGROUP HEALTH PLAN
MOA13364OtherMERCY HEALTH PLAN
MO161200OtherBLUE SHIELD
MO202528048Medicaid
MO4061166OtherAETNA
MOSTL2500039OtherUNITED HEALTHCARE
MO060069533OtherRAILROAD MEDICARE
MO161200OtherBLUE CHOICE
MOSTM2500039OtherUHC MEDICARE COMPLETE
MO254499OtherHEALTHLINK
MOSTL2500039OtherUNITED HEALTHCARE
MOA13364OtherMERCY HEALTH PLAN