Provider Demographics
NPI:1578510194
Name:MIDWEST INFECTIOUS DISEASE SPECIALISTS LLC
Entity Type:Organization
Organization Name:MIDWEST INFECTIOUS DISEASE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-254-2552
Mailing Address - Street 1:19201 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6910
Mailing Address - Country:US
Mailing Address - Phone:816-254-2552
Mailing Address - Fax:816-833-4155
Practice Address - Street 1:19201 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6910
Practice Address - Country:US
Practice Address - Phone:816-254-2552
Practice Address - Fax:816-833-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507620706Medicaid
KS200590210 AMedicaid
MO36315014OtherBCBS OF KC
KS200590210 AMedicaid
MO507620706Medicaid