| Specialist in Aging Successfully LLC | |
|
3466 Bridgeland Dr Ste 105 Bridgeton MO 63044-2606 | |
| (314) 209-5100 | |
| Not Available |
| Full Name | Specialist in Aging Successfully LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3466 Bridgeland Dr Ste 105, Bridgeton, Missouri |
| Authorized Official Name and Position | Asif Bhutto (MEMBER) |
| Authorized Official Contact | 3142095100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialist in Aging Successfully LLC Po Box 8356 Saint Louis MO 63132-0356 Ph: (314) 209-5100 | Specialist in Aging Successfully LLC 3466 Bridgeland Dr Ste 105 Bridgeton MO 63044-2606 Ph: (314) 209-5100 |
| NPI Number | 1023572690 |
|---|---|
| Provider Enumeration Date | 01/28/2019 |
| Last Update Date | 03/15/2021 |
| Certification Date | 03/15/2021 |
| Medicare PECOS PAC ID | 8022358183 |
|---|---|
| Medicare Enrollment ID | O20190327002347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023572690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Asif Shahzad Bhutto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205093473 PECOS PAC ID: 0648342717 Enrollment ID: I20080707000307 |
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