Provider Demographics
NPI:1033303417
Name:INFECTION SOLUTION PLLC
Entity Type:Organization
Organization Name:INFECTION SOLUTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHIDUZZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:586-573-5143
Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-573-5143
Mailing Address - Fax:586-573-5525
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-573-5143
Practice Address - Fax:586-573-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4499470Medicaid
MIH22913Medicare UPIN
MIOP02380Medicare PIN