MEDICARE: FELICIA R BENTLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	036107319	IL
2	207RN0300X	Nephrology Physician	2002015961	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154393437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA R BENTLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 1449
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-0449
Country	:	US
Telephone Number	:	314-438-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7928
Country	:	US
Telephone Number	:	314-438-0700
Fax Number	:	314-438-0737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	08/09/2023

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Directions to “ FELICIA R BENTLEY MD” Practice Location

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