Provider Demographics
NPI:1700819562
Name:INFECTIOUS DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-222-5999
Mailing Address - Street 1:1805 KIMBERLY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2061
Mailing Address - Country:US
Mailing Address - Phone:618-355-9970
Mailing Address - Fax:618-355-9972
Practice Address - Street 1:4550 MEMORIAL DR STE 360
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5369
Practice Address - Country:US
Practice Address - Phone:618-222-5999
Practice Address - Fax:618-239-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102100207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102100Medicaid
IL036102100Medicaid
K15919Medicare PIN
H35380Medicare UPIN
211289Medicare PIN