Provider Demographics
NPI:1730294117
Name:INFECTIOUS DISEASES ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-3883
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2378
Mailing Address - Country:US
Mailing Address - Phone:415-923-3883
Mailing Address - Fax:415-749-5705
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2378
Practice Address - Country:US
Practice Address - Phone:415-923-3883
Practice Address - Fax:415-749-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG039318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty