Healthcare Provider Details

I. General information

NPI: 1518955772
Provider Name (Legal Business Name): INFECTIOUS DISEASES ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S OSPREY AVE SUITE 1
SARASOTA FL
34239-2938
US

IV. Provider business mailing address

1425 S OSPREY AVE SUITE 1
SARASOTA FL
34239-2938
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-9060
  • Fax: 941-552-1588
Mailing address:
  • Phone: 941-366-9060
  • Fax: 941-552-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LORI BRAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-366-9060