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General NPI Number Information
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NPI Number | 1063829562
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDICAL CONSULTANT LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 7011 W 121ST ST STE 106
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2029
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Country | US
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Telephone | 913-884-1055
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Fax | 913-884-1066
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Provider Business Mailing Address
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Address Line | 7011 W 121ST ST STE 106
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2029
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Country | US
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Telephone | 913-884-1055
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Fax | 913-884-1066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID D EDALATI
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Credential | MD
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Telephone | 913-884-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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