Provider Demographics
NPI:1629095534
Name:INFECTIOUS DISEASE CENTER, P.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKSHAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-888-7719
Mailing Address - Street 1:24350 ORCHARD LAKE RD
Mailing Address - Street 2:STE. 115
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1970
Mailing Address - Country:US
Mailing Address - Phone:248-888-7719
Mailing Address - Fax:248-888-7817
Practice Address - Street 1:24350 ORCHARD LAKE RD
Practice Address - Street 2:STE. 115
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1970
Practice Address - Country:US
Practice Address - Phone:248-888-7719
Practice Address - Fax:248-888-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
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
MI=========OtherGROUP TAX ID NUMBER
MI0M73220Medicare UPIN