Organization
MID WEST CLINICAL PRACTICE LLC
Active
Organization
MID WEST CLINICAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANIRUL TAMAL MD (OWNER)
(917) 500-3356
Entity
Organization
Contact information
Practice address
15345 SCHOETTLER ESTATES DR, CHESTERFIELD, MO 63017-5461
(917) 500-3356
(636) 778-9569
Mailing address
15345 SCHOETTLER ESTATES DR, CHESTERFIELD, MO 63017-5461
(917) 500-3356
(636) 778-9569
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017013699
LICENSE NUMBER
MO
Enumeration date
12/01/2022
Last updated
06/06/2025
Update your record
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