Basic Information
| Provider Information | |||||||||
| NPI: | 1225477581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAI | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | ZHAO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 FOREST PARK AVE | ||||||||
| Address2: | FLOOR 2, SUITE 241 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143625000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3015 N BALLAS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149965772 | ||||||||
| FaxNumber: | 3149967691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2013018246 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2015007382 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.