Organization
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Active
Organization
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Active
Other names
MIDC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL M PETRAK MD (MANAGING PARTNER)
(888) 220-6432
Entity
Organization
Contact information
Practice address
4601 W 109TH ST STE 100, OVERLAND PARK, KS 66211-1313
(913) 942-0540
(630) 528-9589
Mailing address
901 MCCLINTOCK DR STE 202, BURR RIDGE, IL 60527-0872
(630) 220-6432
(630) 654-4253
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201170330A
—
KS
Enumeration date
06/21/2019
Last updated
06/21/2019
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