MEDICARE: INFECTIOUS DISEASE MEDICAL CARE PA

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	:	1538771803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASE MEDICAL CARE PA

Provider Business Mailing Address
First Line	:	5258 LINTON BLVD STE 203
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6529
Country	:	US
Telephone Number	:	561-495-7570
Fax Number	:	561-496-7074

Provider Business Practice Location Address
First Line	:	5258 LINTON BLVD STE 203
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6529
Country	:	US
Telephone Number	:	561-495-7570
Fax Number	:	561-496-7074

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	HAMED A KOMAIHA
Credential	:	MD
Telephone Number	:	561-495-7570

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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