Basic Information
| Provider Information | |||||||||
| NPI: | 1811154354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO INFECTIOUS DISEASE CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 MC CLINTOCK DRIVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605270844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882206432 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 FRANKLIN AVENUE | ||||||||
| Address2: | SUTIE 230C | ||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617613588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882206432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 12/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | KOWALSKI | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8882206432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 00009202 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.