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General NPI Number Information
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NPI Number | 1538331954
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Entity Type | Organization
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Legal Business Name | MID WEST INFECTIOUS DISEASE
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 830 W HIGH ST SUITE 250
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City | LIMA
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State | OH
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Zip | 45801-3971
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Country | US
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Telephone | 419-296-8309
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Fax | 419-226-9633
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Provider Business Mailing Address
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Address Line | 2510 BREEZEWOOD LN
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City | LIMA
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State | OH
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Zip | 45805-3893
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Country | US
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Telephone | 419-296-8309
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. SOLOMON MEHARI BERAKI
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Credential | M.D.
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Telephone | 419-296-8309
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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 | 35087816
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License Number State | OH
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