Organization
METRO INFECTIOUS DISEASE CONSULTANTS, LLC
Active
Other names
MIDC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL M PETRAK (MANAGING PARTNER)
(888) 220-6432
Entity
Organization
Contact information
Practice address
2340 E MEYER BLVD, BLDG 2, STE 392, KANSAS CITY, MO 64132-1129
(816) 444-7977
(816) 361-8938
Mailing address
901 MCCLINTOCK DR STE 202, BURR RIDGE, IL 60527-0872
(888) 220-6432
(630) 654-4253
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502397706
—
MO
Enumeration date
07/20/2018
Last updated
07/15/2021
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