MEDICARE: MERIDIAN INFECTIOUS DISEASE CONSULTANTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1154992170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN INFECTIOUS DISEASE CONSULTANTS, PLLC

Provider Business Mailing Address
First Line	:	2830 S. HULEN ST. #858
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1514
Country	:	US
Telephone Number	:	817-718-6648
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY STE 205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4131
Country	:	US
Telephone Number	:	817-841-9447
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	CERES TIU
Credential	:	MD
Telephone Number	:	817-718-6648

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	05/19/2023

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