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General NPI Number Information
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NPI Number | 1932693884
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Entity Type | Organization
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Legal Business Name | MIDWEST INFECTIOUS DISEASES ASSOCIATES LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 751 E 81ST AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5538
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Country | US
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Telephone | 219-895-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W TAM O SHANTER DR
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City | CRETE
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State | IL
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Zip | 60417-6302
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Country | US
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Telephone | 708-334-9738
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Fax | 708-672-9768
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. HENRY ANDOH
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Credential | MD
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Telephone | 219-895-1185
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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 | 01042402
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License Number State | IN
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