| Northwest Infectious Disease Services Llc | |
|
12774 Boenker Ln Bridgeton MO 63044 | |
| (314) 291-7997 | |
| (314) 739-1471 |
| Full Name | Northwest Infectious Disease Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12774 Boenker Ln, Bridgeton, Missouri |
| Authorized Official Name and Position | Phillip G Zinser (MANAGING PARTNER) |
| Authorized Official Contact | 3142917997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Infectious Disease Services Llc Po Box 776874 Chicago IL 60677-6874 Ph: (314) 291-7997 | Northwest Infectious Disease Services Llc 12774 Boenker Ln Bridgeton MO 63044 Ph: (314) 291-7997 |
| NPI Number | 1306891551 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 12/21/2023 |
| Medicare PECOS PAC ID | 0446216063 |
|---|---|
| Medicare Enrollment ID | O20041206000860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306891551 | NPI | - | NPPES |
| 507780401 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Shahzad Hasan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508812579 PECOS PAC ID: 7113964396 Enrollment ID: I20050408000956 |
| Provider Name | Adnan Y Siddiqui |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1134194327 PECOS PAC ID: 7810910460 Enrollment ID: I20060110000071 |
| Provider Name | Jin Wang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477790459 PECOS PAC ID: 7618022625 Enrollment ID: I20090827000038 |
| Provider Name | Phillip G Zinser |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1750346904 PECOS PAC ID: 9638181290 Enrollment ID: I20100202000767 |
| Provider Name | Molly F Caldwell Mcmillan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1417070327 PECOS PAC ID: 9133306046 Enrollment ID: I20110601000820 |
| Provider Name | Kongkeo Thiky Walther |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528433430 PECOS PAC ID: 7618275041 Enrollment ID: I20160418001742 |
| Provider Name | Julie A Shapiro |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1831486364 PECOS PAC ID: 7911209309 Enrollment ID: I20160721001456 |
| Provider Name | Duong T Ho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356792196 PECOS PAC ID: 8729373915 Enrollment ID: I20160826002006 |
| Provider Name | Van B Ho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144844309 PECOS PAC ID: 5597176883 Enrollment ID: I20201117001794 |
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