Provider Demographics
NPI:1164518825
Name:AKRON INFECTIOUS DISEASE, INC
Entity Type:Organization
Organization Name:AKRON INFECTIOUS DISEASE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-375-3894
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-375-3894
Mailing Address - Fax:330-375-6680
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-3894
Practice Address - Fax:330-375-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0197B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278833Medicaid
OHG660006Medicare UPIN
OH2278833Medicaid