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General NPI Number Information
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NPI Number | 1104909530
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Entity Type | Organization
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Legal Business Name | CONTRA COSTA INFECTIOUS DISEASE MEDICAL GROUP INC.
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 3301 CLAYTON RD
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City | CONCORD
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State | CA
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Zip | 94519-2820
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Country | US
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Telephone | 925-671-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 CLAYTON RD
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City | CONCORD
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State | CA
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Zip | 94519-2820
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Country | US
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Telephone | 925-671-7629
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ELLIOT EIN
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Credential | M.D.
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Telephone | 925-366-4383
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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 | G277481
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License Number State | CA
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