Provider Demographics
NPI:1285910943
Name:RED SEA INFECTIOUS DISEASES, LLC
Entity type:Organization
Organization Name:RED SEA INFECTIOUS DISEASES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-974-6611
Mailing Address - Street 1:4410 W UNION HILLS DR
Mailing Address - Street 2:# 7, PMB # 280
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1660
Mailing Address - Country:US
Mailing Address - Phone:623-974-6611
Mailing Address - Fax:623-974-9434
Practice Address - Street 1:14502 W MEEKER BLVD
Practice Address - Street 2:PHYSICIAN IS A HOSPITALIST
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5282
Practice Address - Country:US
Practice Address - Phone:623-974-6611
Practice Address - Fax:623-974-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45091207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty