Provider Demographics
NPI:1235435363
Name:INFECTIOUS DISEASE CENTER, P.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKSHAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-888-7719
Mailing Address - Street 1:24350 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1970
Mailing Address - Country:US
Mailing Address - Phone:248-888-7719
Mailing Address - Fax:248-478-1071
Practice Address - Street 1:24350 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1970
Practice Address - Country:US
Practice Address - Phone:248-888-7719
Practice Address - Fax:248-478-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009519332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5521510003Medicare PIN