| Mid West Clinical Practice Llc | |
|
728 Forest Trace Dr Chesterfield MO 63017-1742 | |
| (347) 285-0627 | |
| Not Available |
| Full Name | Mid West Clinical Practice Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 728 Forest Trace Dr, Chesterfield, Missouri |
| Authorized Official Name and Position | Manirul Tamal (OWNER) |
| Authorized Official Contact | 9175003356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid West Clinical Practice Llc 728 Forest Trace Dr Chesterfield MO 63017-1742 Ph: (347) 285-0627 | Mid West Clinical Practice Llc 728 Forest Trace Dr Chesterfield MO 63017-1742 Ph: (347) 285-0627 |
| NPI Number | 1396455150 |
|---|---|
| Provider Enumeration Date | 12/01/2022 |
| Last Update Date | 12/01/2022 |
| Medicare PECOS PAC ID | 5193194199 |
|---|---|
| Medicare Enrollment ID | O20221214001796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396455150 | NPI | - | NPPES |
| 2017013699 | Other | MO | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Manirul H Tamal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932638129 PECOS PAC ID: 9436577368 Enrollment ID: I20200909002652 |
| Provider Name | Marufa Yesmin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114671039 PECOS PAC ID: 5597135749 Enrollment ID: I20230104000298 |
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