Organization
INNOVATIVE PHYSICIAN ASSOCIATES LLC
Active
Parent organization
METRO INFECTIOUS DISEASE CONSULTANTS,LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
METRO INFECTIOUS DISEASE CONSULTANTS,LLC
Authorized official
RUSSELL M. PETRAK M.D. (MANAGING PARTNER)
(888) 220-6432
Entity
Organization
Contact information
Practice address
901 MCCLINTOCK DRIVE, SUITE 202, BURR RIDGE, IL 60527-0844
(888) 220-6432
(630) 734-4715
Mailing address
901 MCCLINTOCK DRIVE, SUITE 202, BURR RIDGE, IL 60527-0844
(888) 220-6432
(630) 734-4715
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
41053311
IL
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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