Provider Demographics
NPI:1588647515
Name:INFECTIOUS DISEASE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOHINEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-435-7590
Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-435-7590
Mailing Address - Fax:260-435-7645
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-435-7590
Practice Address - Fax:260-435-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN665880Medicare ID - Type Unspecified