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General NPI Number Information
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NPI Number | 1215184916
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Entity Type | Organization
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Legal Business Name | METRO INFECTIOUS DISEASE CONSULTANTS, LLC
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 901 MCCLINTOCK DRIVE SUITE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0844
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Country | US
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Telephone | 888-220-6432
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Fax | 630-654-4253
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Provider Business Mailing Address
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Address Line | 901 MCCLINTOCK DRIVE SUITE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0844
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Country | US
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Telephone | 888-220-6432
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Fax | 630-654-4253
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TARA KOWALSKI
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Credential |
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Telephone | 888-220-6432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 054015148
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License Number State | IL
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