Provider Demographics
NPI:1225470917
Name:INFECTIOUS DISEASES ASSOCIATES OF SOUTHWEST OHIO, LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES OF SOUTHWEST OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANWER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-336-2288
Mailing Address - Street 1:7577 CENTRAL PARKE BLVD
Mailing Address - Street 2:STE 117
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6810
Mailing Address - Country:US
Mailing Address - Phone:513-770-4100
Mailing Address - Fax:513-770-0420
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:STE 117
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6810
Practice Address - Country:US
Practice Address - Phone:513-770-4100
Practice Address - Fax:513-770-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201353370BMedicaid
OH0086663Medicaid
IN201353370CMedicaid
IN201353370AMedicaid
IN201353370AMedicaid