Provider Demographics
NPI:1992906655
Name:CONSULTANTS IN INFECTIOUS DISEASES LLC
Entity type:Organization
Organization Name:CONSULTANTS IN INFECTIOUS DISEASES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-491-5117
Mailing Address - Street 1:5670 54TH AVENUE NORTH
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2067
Mailing Address - Country:US
Mailing Address - Phone:727-548-0260
Mailing Address - Fax:727-548-0270
Practice Address - Street 1:5670 54TH AVENUE NORTH
Practice Address - Street 2:SUITE A-1
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-2067
Practice Address - Country:US
Practice Address - Phone:727-548-0260
Practice Address - Fax:727-548-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014046500Medicaid
FL34308OtherBCBS
FL269114100Medicaid
FLK3611Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLK3611Medicare UPIN