| Midc | |
|
2340 E Meyer Blvd, Bldg 2 Ste 392 Kansas City MO 64132-1129 | |
| (816) 444-7977 | |
| (816) 361-8938 |
| Full Name | Midc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2340 E Meyer Blvd, Bldg 2, Kansas City, Missouri |
| Authorized Official Name and Position | Russell M Petrak (MANAGING PARTNER) |
| Authorized Official Contact | 8882206432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midc 901 Mcclintock Dr Ste 202 Burr Ridge IL 60527-0872 Ph: (888) 220-6432 | Midc 2340 E Meyer Blvd, Bldg 2 Ste 392 Kansas City MO 64132-1129 Ph: (816) 444-7977 |
| NPI Number | 1598242778 |
|---|---|
| Provider Enumeration Date | 07/20/2018 |
| Last Update Date | 07/15/2021 |
| Medicare PECOS PAC ID | 3072425784 |
|---|---|
| Medicare Enrollment ID | O20171127001426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598242778 | NPI | - | NPPES |
| 502397706 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (Missouri) | Primary |
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