Metro Infectious Disease Consultants, LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

METRO INFECTIOUS DISEASE CONSULTANTS, LLC

Doing business as

Midc

Practice address

4601 W 109TH St Ste 100
Overland Park, KS 66211-1313

Phone

(913) 942-0540

Fax

(630) 528-9589

NPI assigned

Jun 21, 2019

Last updated

Jun 21, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Russell M Petrak, MDNPI 1376539692

Title

Managing Partner

Phone

(888) 220-6432

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MIDC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Russell M Petrak, MD

  • Infectious Disease Physician
  • Burr Ridge, IL
  • NPI 1376539692
  Authorized official Same address or phone

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1427619386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR STE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "630-220-6432",
            "fax_number": "630-654-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 W 109TH ST STE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111313",
            "telephone_number": "913-942-0540",
            "fax_number": "630-528-9589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO INFECTIOUS DISEASE CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-21",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "PETRAK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "888-220-6432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201170330A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Infectious Disease Physician in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Infectious Disease Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; 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.