Provider Demographics
NPI:1568883494
Name:INFECTIOUS DISEASE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS, P.C.
Other - Org Name:INFECTIOUS DISEASE SPECIALISTS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-972-1625
Mailing Address - Street 1:9143 INDIANAPOLIS BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2500
Mailing Address - Country:US
Mailing Address - Phone:219-972-1625
Mailing Address - Fax:219-972-1651
Practice Address - Street 1:9143 INDIANAPOLIS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2577
Practice Address - Country:US
Practice Address - Phone:219-972-1625
Practice Address - Fax:219-972-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0003X, 3336C0004X
IN60005599A3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133167OtherPK
2133167OtherPK