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General NPI Number Information
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NPI Number | 1598242778
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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 | 07/20/2018
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 2340 E MEYER BLVD, BLDG 2 STE 392
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City | KANSAS CITY
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State | MO
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Zip | 64132-1129
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Country | US
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Telephone | 816-444-7977
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Fax | 816-361-8938
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Provider Business Mailing Address
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Address Line | 901 MCCLINTOCK DR STE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0872
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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 | MANAGING PARTNER
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Name | RUSSELL M PETRAK
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | MO
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