Healthcare Provider Details

I. General information

NPI: 1538771803
Provider Name (Legal Business Name): INFECTIOUS DISEASE MEDICAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6529
US

IV. Provider business mailing address

5258 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6529
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-7570
  • Fax: 561-496-7074
Mailing address:
  • Phone: 561-495-7570
  • Fax: 561-496-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMED A KOMAIHA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 561-495-7570