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NPI Code Detail

MEDICARE: MARY EHLMAN MD

MEDICARE: MARY EHLMAN 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
1207R00000XInternal Medicine Physician2013020999MO

General Provider Information

NPI Number : 1235579012
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY EHLMAN MD
Provider Business Mailing Address
First Line : 670 MASON RIDGE CENTER DR
Second Line : STE 300
City : SAINT LOUIS
State : MO
Zip : 63141
Country : US
Telephone Number : 314-525-0490
Fax Number : 314-525-0434
Provider Business Practice Location Address
First Line : 3844 S LINDBERGH BLVD STE 120
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1369
Country : US
Telephone Number : 314-525-0434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2013
Last Update Date : 07/21/2022

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