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General NPI Number Information
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NPI Number | 1154992170
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Entity Type | Organization
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Legal Business Name | MERIDIAN INFECTIOUS DISEASE CONSULTANTS, PLLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 6100 HARRIS PKWY STE 205
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City | FORT WORTH
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State | TX
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Zip | 76132-4131
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Country | US
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Telephone | 817-841-9447
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Fax |
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Provider Business Mailing Address
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Address Line | 2830 S. HULEN ST. #858
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City | FORT WORTH
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State | TX
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Zip | 76109-1514
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Country | US
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Telephone | 817-718-6648
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | CERES TIU
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Credential | MD
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Telephone | 817-718-6648
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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 |
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License Number State |
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