Healthcare Provider Details

I. General information

NPI: 1588647515
Provider Name (Legal Business Name): INFECTIOUS DISEASE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD SUITE 305
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

7910 W JEFFERSON BLVD SUITE 305
FORT WAYNE IN
46804-4159
US

V. Phone/Fax

Practice location:
  • Phone: 260-435-7590
  • Fax: 260-435-7645
Mailing address:
  • Phone: 260-435-7590
  • Fax: 260-435-7645

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: BARBARA NOHINEK
Title or Position: PHYSICIAN/EMPLOYEE
Credential: M.D.
Phone: 260-435-7590