Healthcare Provider Details

I. General information

NPI: 1447305313
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULTANTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE SUITE 214
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

2740 W FOSTER AVE SUITE 214
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-3400
  • Fax: 773-506-2668
Mailing address:
  • Phone: 773-907-3400
  • Fax: 773-506-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042005824
License Number StateIL

VIII. Authorized Official

Name: DR. STEVE B. KALISH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-907-3400