MEDICARE: BAVARIA MEDDAC

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	261QP2300X	Primary Care Clinic/Center	4704257576	MI

General Provider Information

NPI Number	:	1205275138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAVARIA MEDDAC

Provider Business Mailing Address
First Line	:	CMR 459 BOX 19908
Second Line	:
City	:	APO
State	:	AE
Zip	:	09139-0020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CMR 459 BOX 19908
Second Line	:
City	:	APO
State	:	AE
Zip	:	09139-0020
Country	:	US
Telephone Number	:	314-469-1750
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. VINCENT BENTLEY
Credential	:	MD
Telephone Number	:	314-469-1750

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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