Provider Demographics
NPI:1538331954
Name:MID WEST INFECTIOUS DISEASE
Entity Type:Organization
Organization Name:MID WEST INFECTIOUS DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:MEHARI
Authorized Official - Last Name:BERAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-296-8309
Mailing Address - Street 1:2510 BREEZEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3893
Mailing Address - Country:US
Mailing Address - Phone:419-296-8309
Mailing Address - Fax:
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-296-8309
Practice Address - Fax:419-226-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087816207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty