Provider Demographics
NPI:1063671089
Name:ORLANDO INFECTIOUS DISEASE CONSULTANCY SERVICES PL
Entity Type:Organization
Organization Name:ORLANDO INFECTIOUS DISEASE CONSULTANCY SERVICES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-350-5917
Mailing Address - Street 1:4156 BROOKMYRA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5109
Mailing Address - Country:US
Mailing Address - Phone:407-350-5917
Mailing Address - Fax:407-350-5928
Practice Address - Street 1:720 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4989
Practice Address - Country:US
Practice Address - Phone:407-350-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88164207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5811Medicare PIN