Provider Demographics
NPI:1790984904
Name:MIDWEST INTERNISTS, PC
Entity Type:Organization
Organization Name:MIDWEST INTERNISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEMETRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-8349
Mailing Address - Street 1:1040 N MASON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6399
Mailing Address - Country:US
Mailing Address - Phone:314-996-8349
Mailing Address - Fax:
Practice Address - Street 1:1040 N MASON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6399
Practice Address - Country:US
Practice Address - Phone:314-996-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105483207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG47973Medicare UPIN