| Midwest Medicine Group, LLC | |
|
14314 Manderleigh Woods Dr Chesterfield MO 63017-8055 | |
| (636) 566-8155 | |
| (636) 566-8732 |
| Full Name | Midwest Medicine Group, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 14314 Manderleigh Woods Dr, Chesterfield, Missouri |
| Authorized Official Name and Position | Manisha Patwardhan (OWNER) |
| Authorized Official Contact | 3143756630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Medicine Group, LLC Po Box 958946 Saint Louis MO 63195-8946 Ph: (636) 566-8155 | Midwest Medicine Group, LLC 14314 Manderleigh Woods Dr Chesterfield MO 63017-8055 Ph: (636) 566-8155 |
| NPI Number | 1528336518 |
|---|---|
| Provider Enumeration Date | 12/06/2011 |
| Last Update Date | 12/06/2011 |
| Medicare PECOS PAC ID | 4385803931 |
|---|---|
| Medicare Enrollment ID | O20120316000681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528336518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2000169533 (Missouri) | Primary |
| Provider Name | Manisha S Patwardhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790755536 PECOS PAC ID: 5193708410 Enrollment ID: I20040609000243 |
| Provider Name | Sanjay a Patwardhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073583803 PECOS PAC ID: 1153307582 Enrollment ID: I20040626000339 |
| Provider Name | Richard G Mrad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972573715 PECOS PAC ID: 4587631502 Enrollment ID: I20040910000411 |
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