| Infectious Diseases & International Medicine Llc | |
|
1514 Vernon Rd Lagrange GA 30240-4131 | |
| (708) 489-9005 | |
| (844) 443-3963 |
| Full Name | Infectious Diseases & International Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1514 Vernon Rd, Lagrange, Georgia |
| Authorized Official Name and Position | Nisha Panicker Aravindakshan Patel (CEO/OWNER) |
| Authorized Official Contact | 5164470795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases & International Medicine Llc 543 Winton Ter Ne Unit A Atlanta GA 30308-2826 Ph: (516) 424-0795 | Infectious Diseases & International Medicine Llc 1514 Vernon Rd Lagrange GA 30240-4131 Ph: (708) 489-9005 |
| NPI Number | 1265003347 |
|---|---|
| Provider Enumeration Date | 07/08/2021 |
| Last Update Date | 03/23/2022 |
| Medicare PECOS PAC ID | 7810394384 |
|---|---|
| Medicare Enrollment ID | O20210927000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265003347 | NPI | - | NPPES |
| 1942527478 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Nisha Panicker Aravindakshan-patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942527478 PECOS PAC ID: 6507173770 Enrollment ID: I20170710003102 |
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