Provider Demographics
NPI:1740207786
Name:SPRINGFIELD INFECTIOUS DISEASES LLC
Entity Type:Organization
Organization Name:SPRINGFIELD INFECTIOUS DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:BURMAWALA
Authorized Official - Last Name:ISMAILJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-322-7260
Mailing Address - Street 1:1174 E HOME RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2726
Mailing Address - Country:US
Mailing Address - Phone:937-322-7260
Mailing Address - Fax:937-398-0358
Practice Address - Street 1:1174 E HOME RD
Practice Address - Street 2:SUITE N
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2726
Practice Address - Country:US
Practice Address - Phone:937-322-7260
Practice Address - Fax:937-398-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083321207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672577Medicaid
OH9362701Medicare PIN