| Infectious Diseases Associates Of Southwest Ohio, Llc | |
|
7577 Central Parke Blvd Ste 117 Mason OH 45040-6810 | |
| (513) 770-4100 | |
| (513) 770-0420 |
| Full Name | Infectious Diseases Associates Of Southwest Ohio, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7577 Central Parke Blvd, Mason, Ohio |
| Authorized Official Name and Position | Anwer H Siddiqui (OWNER) |
| Authorized Official Contact | 5133362288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases Associates Of Southwest Ohio, Llc 7577 Central Parke Blvd Ste 117 Mason OH 45040-6810 Ph: (513) 770-4100 | Infectious Diseases Associates Of Southwest Ohio, Llc 7577 Central Parke Blvd Ste 117 Mason OH 45040-6810 Ph: (513) 770-4100 |
| NPI Number | 1225470917 |
|---|---|
| Provider Enumeration Date | 07/23/2013 |
| Last Update Date | 09/27/2016 |
| Medicare PECOS PAC ID | 5597999136 |
|---|---|
| Medicare Enrollment ID | O20131014001472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225470917 | NPI | - | NPPES |
| 201353370B | Medicaid | IN | |
| 0086663 | Medicaid | OH | |
| 201353370C | Medicaid | IN | |
| 201353370A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Anwer Siddiqui |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1336115450 PECOS PAC ID: 9335282797 Enrollment ID: I20100207000004 |
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