Provider Demographics
NPI:1346467628
Name:HOOSIER INFECTIOUS DISEASE CONSULTANTS, PC
Entity Type:Organization
Organization Name:HOOSIER INFECTIOUS DISEASE CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-690-1733
Mailing Address - Street 1:704 S STATE ROAD 135 STE D293
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6561
Mailing Address - Country:US
Mailing Address - Phone:317-690-1733
Mailing Address - Fax:
Practice Address - Street 1:1101 W JEFFERSON ST STE S
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2728
Practice Address - Country:US
Practice Address - Phone:317-346-3892
Practice Address - Fax:317-745-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043261A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF48968Medicare UPIN
IN251190Medicare PIN