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NPI Code Detail

MEDICARE: MID AMERICA INFECTIOUS DISEASE CONSULTANTS PC

MEDICARE: MID AMERICA INFECTIOUS DISEASE CONSULTANTS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0200XInfectious Disease Physician111192MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2440003964OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528164217
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID AMERICA INFECTIOUS DISEASE CONSULTANTS PC
Provider Business Mailing Address
First Line : 3215 MAIN ST STE 100B
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-1946
Country : US
Telephone Number : 816-561-2433
Fax Number : 816-931-8721
Provider Business Practice Location Address
First Line : 3215 MAIN ST STE 100B
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-1946
Country : US
Telephone Number : 816-561-2433
Fax Number : 816-931-8721
Authorized Official
Title or Position : OFFICE MANAGER
Name : CISCO SHERMAN
Credential :
Telephone Number : 816-561-8125
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/21/2016

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Directions to “MID AMERICA INFECTIOUS DISEASE CONSULTANTS PC ” Practice Location

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