Healthcare Provider Details

I. General information

NPI: 1316339104
Provider Name (Legal Business Name): PREMIER SPECIALISTS IN INFECTIOUS DISEASE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 DRESSLER RD NW
CANTON OH
44718-2752
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 216-849-0766
  • Fax:
Mailing address:
  • Phone: 330-479-8705
  • Fax: 330-479-9330

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: DR. BADIE AL NEMR
Title or Position: OWNER
Credential:
Phone: 216-849-0766