Organization
METRO INFECTIOUS DISEASE CONSULTANTS LLC
Active
Parent organization
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Other names
MIDC PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Authorized official
DR. RUSSELL MARTIN PETRAK MD (MANAGING PARTNER)
(630) 986-4580
Entity
Organization
Contact information
Practice address
901 MCCLINTOCK DR, SUITE 104, BURR RIDGE, IL 60527-0844
(630) 986-4580
(630) 528-9600
Mailing address
901 MCCLINTOCK DR, STE 104, BURR RIDGE, IL 60527-0844
(630) 986-4580
(630) 528-9600
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
054-015148
IL
3336C0003X
Community/Retail Pharmacy
Primary
054015148
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032-008061
CONTROLLED SUBSTANCE
IL
Enumeration date
09/22/2005
Last updated
03/07/2023
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