Provider Demographics
NPI:1609047323
Name:INFECTIOUS DISEASE ASSOCIATES OF THE PALM BEACHES INC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF THE PALM BEACHES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ERLINDA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-776-8300
Mailing Address - Street 1:840 US HIGHWAY 1
Mailing Address - Street 2:STE 120
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3830
Mailing Address - Country:US
Mailing Address - Phone:561-776-8300
Mailing Address - Fax:561-776-0727
Practice Address - Street 1:840 US HIGHWAY 1
Practice Address - Street 2:STE 120
Practice Address - City:N PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3830
Practice Address - Country:US
Practice Address - Phone:561-776-8300
Practice Address - Fax:561-776-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064006207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0508Medicare PIN