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General NPI Number Information
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NPI Number | 1043308141
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES CONSULTANTS, P.A.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 21205 OLEAN BLVD STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6756
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Country | US
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Telephone | 941-613-2800
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Fax | 941-613-2801
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Provider Business Mailing Address
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Address Line | 21205 OLEAN BLVD STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6756
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Country | US
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Telephone | 941-613-2800
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Fax | 941-613-2801
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EILEEN RICHARD
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Credential |
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Telephone | 941-613-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0056397
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License Number State | FL
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