Provider Demographics
NPI:1669889978
Name:INFECTIOUS DISEASE CONSULTANTS, P.A.
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-833-1212
Mailing Address - Street 1:310 S HILLSIDE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2129
Mailing Address - Country:US
Mailing Address - Phone:316-833-1212
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:310 S HILLSIDE ST STE 150
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2129
Practice Address - Country:US
Practice Address - Phone:316-833-1212
Practice Address - Fax:316-264-0908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFECTIOUS DISEASE CONSULTANTS P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-130413336H0001X, 3336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy