MEDICARE: MARYLAND MEDICAL GROUP LTD

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1104870021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND MEDICAL GROUP LTD

Provider Business Mailing Address
First Line	:	1110 HIGHLANDS PLAZA DR E
Second Line	:	SUITE 375
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1340
Country	:	US
Telephone Number	:	314-367-3113
Fax Number	:	314-367-6491

Provider Business Practice Location Address
First Line	:	1110 HIGHLANDS PLAZA DRIVE EAST
Second Line	:	SUITE 375
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1340
Country	:	US
Telephone Number	:	314-367-3113
Fax Number	:	314-367-6491

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM G BOWEN
Credential	:	MD
Telephone Number	:	314-367-3113

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/01/2008

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Directions to “MARYLAND MEDICAL GROUP LTD ” Practice Location

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