Provider Demographics
NPI:1043308141
Name:INFECTIOUS DISEASES CONSULTANTS, P.A.
Entity type:Organization
Organization Name:INFECTIOUS DISEASES CONSULTANTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-613-2800
Mailing Address - Street 1:21205 OLEAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6756
Mailing Address - Country:US
Mailing Address - Phone:941-613-2800
Mailing Address - Fax:941-613-2801
Practice Address - Street 1:21205 OLEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6756
Practice Address - Country:US
Practice Address - Phone:941-613-2800
Practice Address - Fax:941-613-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056397207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL440002698OtherRR MEDICARE
FLP00338188OtherRR MEDICARE
FL271223700Medicaid
FLI22783Medicare UPIN
FL50777YMedicare ID - Type UnspecifiedK. DAMIANI, M.D.