Provider Demographics
NPI:1497705669
Name:INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, INC.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAUREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-251-4787
Mailing Address - Street 1:2222 CHERRY ST
Mailing Address - Street 2:STE 1400
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2673
Mailing Address - Country:US
Mailing Address - Phone:419-251-4787
Mailing Address - Fax:419-251-6785
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:STE 1400
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-4787
Practice Address - Fax:419-251-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCC3611OtherRAILROAD MEDICARE
OH9192952Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER