MEDICARE: PHOENIX INFECTIOUS DISEASES CONSULTANTS LLC

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	30584	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71505	OTHER		MEDICARE UNSPEC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235305574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX INFECTIOUS DISEASES CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	530 E MCDOWELL RD STE 107-609
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1549
Country	:	US
Telephone Number	:	602-790-4108
Fax Number	:	623-218-9209

Provider Business Practice Location Address
First Line	:	3330 N 2ND ST STE 401
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2371
Country	:	US
Telephone Number	:	602-254-1136
Fax Number	:	602-279-1720

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	DR. NDIDIAMAKA U OBIESIE
Credential	:	MD
Telephone Number	:	602-790-4108

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	12/02/2014

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Directions to “PHOENIX INFECTIOUS DISEASES CONSULTANTS LLC ” Practice Location

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