MEDICARE: INFECTIOUS DISEASE ASSOCIATES LLC

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

General Provider Information

NPI Number	:	1871506543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 5921
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85385-5921
Country	:	US
Telephone Number	:	602-206-0403
Fax Number	:	623-362-2954

Provider Business Practice Location Address
First Line	:	19841 N 27TH AVE
Second Line	:	SUITE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4003
Country	:	US
Telephone Number	:	602-206-0403
Fax Number	:	623-362-2954

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. NGOZI ADAMMA OSONDU
Credential	:	M.D
Telephone Number	:	602-206-0403

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	05/12/2008

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