Basic Information
| Provider Information | |||||||||
| NPI: | 1861163958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CONSULTING NETWORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7731 | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630067731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363334500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10010 KENNERLY RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143446000 | ||||||||
| FaxNumber: | 3312412216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | BERHIL | ||||||||
| AuthorizedOfficialFirstName: | ANIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO, MD | ||||||||
| AuthorizedOfficialTelephone: | 9786770038 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.