1679829469 NPI number — INFECTIOUS DISEASES CONSULTANTS LLC

Table of content: DR. DOUGLAS MARK BRADSHAW MD (NPI 1952333072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679829469 NPI number — INFECTIOUS DISEASES CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASES CONSULTANTS LLC
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:
1679829469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70896-5163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-381-2782
Provider Business Mailing Address Fax Number:
225-381-2799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 NORTH BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-381-2782
Provider Business Practice Location Address Fax Number:
225-381-2799
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NJOKU
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
OKWUDILI
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
225-930-4517

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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