Provider Demographics
NPI:1245425271
Name:INFECTIOUS DISEASE CONSULTANTS LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAFFOE-BONNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-682-6686
Mailing Address - Street 1:PO BOX 91177
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1177
Mailing Address - Country:US
Mailing Address - Phone:863-682-6686
Mailing Address - Fax:863-682-5566
Practice Address - Street 1:202 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4548
Practice Address - Country:US
Practice Address - Phone:863-682-6686
Practice Address - Fax:863-682-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66940Medicare UPIN
K3358Medicare PIN