Provider Demographics
NPI:1568180925
Name:MIDWEST IDKC LLC
Entity type:Organization
Organization Name:MIDWEST IDKC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-274-1573
Mailing Address - Street 1:PO BOX 8031
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-0031
Mailing Address - Country:US
Mailing Address - Phone:913-274-1573
Mailing Address - Fax:763-294-8335
Practice Address - Street 1:205 NW R D MIZE RD STE 105
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2519
Practice Address - Country:US
Practice Address - Phone:913-274-1573
Practice Address - Fax:763-294-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty