Healthcare Provider Details

I. General information

NPI: 1669380614
Provider Name (Legal Business Name): INFECTIOUS DISEASE MANAGEMENT INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 COLD SPRING RD
INDIANAPOLIS IN
46222-2272
US

IV. Provider business mailing address

701 N FEDERAL HWY STE 501
HALLANDALE BEACH FL
33009-2467
US

V. Phone/Fax

Practice location:
  • Phone: 317-923-1518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ERIC JARQUIN
Title or Position: FINANCIAL CONTROLLER
Credential:
Phone: 954-651-8332