Organization
INTERNAL MEDICINE CONSULTANTS II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW BOSNER MD (DELEGATED OFFICIAL)
(314) 569-1090
Entity
Organization
Contact information
Practice address
456 N NEW BALLAS RD, SUITE 299, SAINT LOUIS, MO 63141-6831
(314) 569-1090
(314) 569-1424
Mailing address
1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R6A89
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501466205
—
MO
01
—
CP7862
RR MEDICARE GROUP#
MO
Enumeration date
01/30/2006
Last updated
09/27/2011
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