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General NPI Number Information
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NPI Number | 1871084426
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES SPECIALTY ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 150 SE 17TH ST STE 801
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City | OCALA
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State | FL
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Zip | 34471
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Country | US
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Telephone | 352-362-6104
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3716
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City | OCALA
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State | FL
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Zip | 34478-3716
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Country | US
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Telephone | 352-362-6104
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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. ANTENEH M. ADDISU
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Credential | MP, PHD
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Telephone | 352-362-6104
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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 | ME75316
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License Number State | FL
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