Provider Demographics
NPI:1518156017
Name:PREMIER INFECTIOUS DISEASE CARE LLC
Entity Type:Organization
Organization Name:PREMIER INFECTIOUS DISEASE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:321-422-3660
Mailing Address - Street 1:2100 ALOMA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3301
Mailing Address - Country:US
Mailing Address - Phone:321-422-3660
Mailing Address - Fax:407-644-2981
Practice Address - Street 1:2100 ALOMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3301
Practice Address - Country:US
Practice Address - Phone:321-422-3660
Practice Address - Fax:407-644-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92663207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8797400Medicaid