Provider Demographics
NPI:1619116183
Name:INFECTIOUS DISEASE & EPIDEMIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE & EPIDEMIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-361-5284
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-343-8780
Mailing Address - Fax:402-343-8787
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-343-8780
Practice Address - Fax:402-343-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid
NE098798Medicare PIN