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NPI Code Detail

MEDICARE: THOMAS MICHAEL BENDER

MEDICARE: THOMAS MICHAEL BENDER
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
12080N0001XNeonatal-Perinatal Medicine Physician107915MO
2208000000XPediatrics Physician107915MO

General Provider Information

NPI Number : 1649278789
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS MICHAEL BENDER
Provider Business Mailing Address
First Line : 3691 RUTGER AVE
Second Line :
City : ST. LOUIS
State : MO
Zip : 63110-2515
Country : US
Telephone Number : 314-977-6828
Fax Number : 314-977-6872
Provider Business Practice Location Address
First Line : 1465 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1003
Country : US
Telephone Number : 314-268-4101
Fax Number : 314-577-5379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 08/27/2015

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Directions to “ THOMAS MICHAEL BENDER ” Practice Location

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