Individual
SHANE A GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12855 N 40 DR STE 180, SAINT LOUIS, MO 63141-8657
(314) 878-5599
(314) 392-4290
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2020038382
MO
Other
Enumeration date
07/28/2014
Last updated
05/05/2023
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