NPIMap

Organization Active NPI

Metro Infectious Disease Consultants LLC

  • Community/Retail Pharmacy
  • Burr Ridge, IL
National Provider Identifier
1184610396
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054015148 Issued in IL
Legal business name
METRO INFECTIOUS DISEASE CONSULTANTS LLC
Practice address
901 McClintock Dr
Suite 104
Burr Ridge, IL 60527-0844
Phone
(630) 986-4580
Fax
(630) 528-9600
NPI assigned
Sep 22, 2005
Organization subpart
Yes
Parent organization
METRO INFECTIOUS DISEASE CONSULTANTS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Russell Martin Petrak, MD
Title
Managing Partner
Phone
(630) 986-4580

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 054-015148 IL
Community/Retail Pharmacy 3336C0003X 054015148 IL Primary

Addresses

Primary practice location

901 McClintock Dr
Suite 104
Burr Ridge, IL 60527-0844

Mailing address

901 McClintock Dr
Ste 104
Burr Ridge, IL 60527-0844
Phone (630) 986-4580

Other identifiers 1

IdentifierTypeStateIssuer
032-008061OtherILCONTROLLED SUBSTANCE

Other names 1

  • MIDC PHARMACY Other name

National Provider Directory

National Provider Directory
Tax ID family
Metro Infectious Disease5 organizations share this tax ID, including this one
Part of
Metro Infectious Disease

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

901 McClintock Dr
Ste 104
Burr Ridge, IL 60527
Phone (630) 986-4580

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1184610396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "STE 104",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270844",
            "telephone_number": "630-986-4580",
            "fax_number": "630-528-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 104",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270844",
            "telephone_number": "630-986-4580",
            "fax_number": "630-528-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METRO INFECTIOUS DISEASE CONSULTANTS, LLC",
        "enumeration_date": "2005-09-22",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "PETRAK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "630-986-4580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "IL",
            "license": "054-015148",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054015148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE",
            "identifier": "032-008061",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDC PHARMACY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.