Provider Demographics
NPI:1063829562
Name:MIDWEST MEDICAL CONSULTANT LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDALATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-884-1055
Mailing Address - Street 1:7011 W 121ST ST
Mailing Address - Street 2:STE 106
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2029
Mailing Address - Country:US
Mailing Address - Phone:913-884-1055
Mailing Address - Fax:913-884-1066
Practice Address - Street 1:7011 W 121ST ST
Practice Address - Street 2:STE 106
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2029
Practice Address - Country:US
Practice Address - Phone:913-884-1055
Practice Address - Fax:913-884-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty