Healthcare Provider Details

I. General information

NPI: 1538331954
Provider Name (Legal Business Name): MID WEST INFECTIOUS DISEASE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST SUITE 250
LIMA OH
45801-3971
US

IV. Provider business mailing address

2510 BREEZEWOOD LN
LIMA OH
45805-3893
US

V. Phone/Fax

Practice location:
  • Phone: 419-296-8309
  • Fax: 419-226-9633
Mailing address:
  • Phone: 419-296-8309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35087816
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SOLOMON MEHARI BERAKI
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 419-296-8309