Provider Demographics
NPI:1265003347
Name:INFECTIOUS DISEASES & INTERNATIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES & INTERNATIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:PANICKER
Authorized Official - Last Name:ARAVINDAKSHAN PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-447-0795
Mailing Address - Street 1:543 WINTON TER NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2826
Mailing Address - Country:US
Mailing Address - Phone:516-424-0795
Mailing Address - Fax:844-443-3963
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:708-489-9005
Practice Address - Fax:844-443-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1942527478OtherNPI