Provider Demographics
NPI:1497111983
Name:INFECTIOUS DISEASES SPECIALIST OF BREVARD LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES SPECIALIST OF BREVARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-750-6579
Mailing Address - Street 1:5701 RUSACK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:951 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3279
Practice Address - Country:US
Practice Address - Phone:321-750-6579
Practice Address - Fax:844-433-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105351207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty