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General NPI Number Information
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NPI Number | 1497111983
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES SPECIALIST OF BREVARD LLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 951 N WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-3279
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Country | US
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Telephone | 321-750-6579
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Fax | 844-433-3836
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Provider Business Mailing Address
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Address Line | 5701 RUSACK DR
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City | MELBOURNE
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State | FL
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Zip | 32940-8017
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Country | US
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Telephone |
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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. NIMESH NAIK
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Credential |
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Telephone | 321-750-6579
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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 | ME105351
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License Number State | FL
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