1952410573 NPI number — FLORIDA INFECTIOUS DISEASE CONSULTANTS P.A

Table of content: (NPI 1952410573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952410573 NPI number — FLORIDA INFECTIOUS DISEASE CONSULTANTS P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA INFECTIOUS DISEASE CONSULTANTS P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952410573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10407 EMERALD WOODS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32836-5971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-229-3505
Provider Business Mailing Address Fax Number:
407-386-9836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HILDA ST
Provider Second Line Business Practice Location Address:
SUITE # 23
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-944-4900
Provider Business Practice Location Address Fax Number:
407-483-0688
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIDDIQUI
Authorized Official First Name:
SHOAIB
Authorized Official Middle Name:
ANWER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-229-3505

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME 75997 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 440002971 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001634100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258319400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48924 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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