Provider Demographics
NPI:1437109733
Name:GULF COAST INFECTIOUS DISEASES INC
Entity Type:Organization
Organization Name:GULF COAST INFECTIOUS DISEASES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-549-4755
Mailing Address - Street 1:PO BOX 11640
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524
Mailing Address - Country:US
Mailing Address - Phone:850-549-4755
Mailing Address - Fax:850-549-4760
Practice Address - Street 1:2120 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-549-4755
Practice Address - Fax:850-549-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL611374600OtherDEPT OF LABOR
AL529928850Medicaid
FL611374600OtherDEPT OF LABOR