Healthcare Provider Details

I. General information

NPI: 1578569893
Provider Name (Legal Business Name): CONSULTANTS IN INFECTIOUS DISEASES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 C 19TH
LUBBOCK TX
79407
US

IV. Provider business mailing address

PO BOX 16327
LUBBOCK TX
79490-6327
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-8150
  • Fax: 806-791-6688
Mailing address:
  • Phone: 806-795-8150
  • Fax: 806-791-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberJ3849
License Number StateTX

VIII. Authorized Official

Name: DR. LAWRENCE P MARTINELLI
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 806-795-8150