| NPI | 1235125717 |
|---|---|
| Doing Business As | MIDC, LLC |
| Entity Type | Organization |
| Authorized Contact | RUSSELL M PETRAK Managing Partner 888-220-6432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: IL 0000920-2) |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-09-10 |