MEDICARE: INFECTIONS MANAGED INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME63353	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407163728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIONS MANAGED INC

Provider Business Mailing Address
First Line	:	3012 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4356
Country	:	US
Telephone Number	:	954-776-9992
Fax Number	:	954-776-9993

Provider Business Practice Location Address
First Line	:	3012 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4356
Country	:	US
Telephone Number	:	954-776-9992
Fax Number	:	954-776-9993

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN A RENAE
Credential	:	M.D.
Telephone Number	:	954-776-9992

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	06/01/2022

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