Healthcare Provider Details

I. General information

NPI: 1841530250
Provider Name (Legal Business Name): METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15474 N HAGGERTY RD
PLYMOUTH MI
48170-4893
US

IV. Provider business mailing address

901 MCCLINTOCK DR SUITE 202
BURR RIDGE IL
60527-0871
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6432
  • Fax: 630-654-4253
Mailing address:
  • Phone: 888-220-6432
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD7110H
License Number StateMI

VIII. Authorized Official

Name: TARA KOWALSKI
Title or Position: MANAGER
Credential:
Phone: 630-655-7290