Organization
MID AMERICA INFECTIOUS DISEASE CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CISCO SHERMAN (OFFICE MANAGER)
(816) 561-8125
Entity
Organization
Contact information
Practice address
3215 MAIN ST STE 100B, KANSAS CITY, MO 64111-1946
(816) 561-2433
(816) 931-8721
Mailing address
3215 MAIN ST STE 100B, KANSAS CITY, MO 64111-1946
(816) 561-2433
(816) 931-8721
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
111192
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440003964
RAILROAD MEDICARE
—
05
—
506075704
—
MO
Enumeration date
09/16/2006
Last updated
07/21/2016
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