Provider Demographics
NPI:1396977963
Name:PHOENIX INFECTIOUS DISEASES CONSULTANTS, LLC
Entity type:Organization
Organization Name:PHOENIX INFECTIOUS DISEASES CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDIDIAMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIESIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-790-4108
Mailing Address - Street 1:340 E PALM LN
Mailing Address - Street 2:A260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4603
Mailing Address - Country:US
Mailing Address - Phone:602-254-1136
Mailing Address - Fax:602-279-1720
Practice Address - Street 1:340 E PALM LN
Practice Address - Street 2:A260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4603
Practice Address - Country:US
Practice Address - Phone:602-254-1136
Practice Address - Fax:602-279-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty