MEDICARE: MIDWEST INFECTIOUS DISEASE SPECIALISTS LLC

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	207RI0200X	Infectious Disease Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	36315014	OTHER	MO	BCBS OF KC

General Provider Information

NPI Number	:	1578510194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST INFECTIOUS DISEASE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE G
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-254-2552
Fax Number	:	816-833-4155

Provider Business Practice Location Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE G
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-254-2552
Fax Number	:	816-833-4155

Authorized Official
Title or Position	:	VP
Name	:	PATRICK J KUENY
Credential	:
Telephone Number	:	816-254-2552

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	03/19/2009

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