Organization
INTERNAL MEDICINE CONSULTANTS II, LLC
Active
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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