Provider Demographics
NPI:1053499046
Name:ASSOCIATES IN INFECTIOUS DISEASES, PSC
Entity Type:Organization
Organization Name:ASSOCIATES IN INFECTIOUS DISEASES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-238-9911
Mailing Address - Street 1:9720 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2288
Mailing Address - Country:US
Mailing Address - Phone:502-425-9138
Mailing Address - Fax:502-425-9161
Practice Address - Street 1:9720 PARK PLAZA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2288
Practice Address - Country:US
Practice Address - Phone:502-425-9138
Practice Address - Fax:502-425-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35413207RI0200X
IN01055144A207RI0200X
KY3005396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB9971OtherRAILROAD MEDICARE
IN200471340AMedicaid
KY65938268Medicaid
IN199780Medicare PIN
IN200471340AMedicaid