Provider Demographics
NPI:1215194717
Name:METRO INFECTIOUS DISEASE CONSULTANTS LLC
Entity type:Organization
Organization Name:METRO INFECTIOUS DISEASE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-220-6432
Mailing Address - Street 1:901 MC CLINTOCK DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0844
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00009202207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL347711Medicare PIN