| Midwest Idkc Llc | |
|
19550 E 39th St S Ste 310 Independence MO 64057-2306 | |
| (913) 274-1573 | |
| (763) 294-8335 |
| Full Name | Midwest Idkc Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19550 E 39th St S Ste 310, Independence, Missouri |
| Authorized Official Name and Position | Atul Gupta (PRESIDENT) |
| Authorized Official Contact | 9132741573 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Idkc Llc Po Box 8031 Prairie Village KS 66208-0031 Ph: (913) 274-1573 | Midwest Idkc Llc 19550 E 39th St S Ste 310 Independence MO 64057-2306 Ph: (913) 274-1573 |
| NPI Number | 1568180925 |
|---|---|
| Provider Enumeration Date | 08/19/2022 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 5991171886 |
|---|---|
| Medicare Enrollment ID | O20221018001256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568180925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Atul Gupta |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1790826063 PECOS PAC ID: 0648348193 Enrollment ID: I20221025002768 |
| Provider Name | Sabrina D Knoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003670258 PECOS PAC ID: 5597104992 Enrollment ID: I20240418000903 |
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