Provider Demographics
NPI:1790774016
Name:INFECTIOUS DISEASES ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNWOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:847-981-3694
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:BROCK 4011
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3694
Mailing Address - Fax:847-981-6508
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:BROCK 4011
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3694
Practice Address - Fax:847-981-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-004299207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH1740Medicare ID - Type UnspecifiedRAILROAD
ILCL0523Medicare ID - Type UnspecifiedRAILROAD
IL749180Medicare ID - Type UnspecifiedCOOK COUNTY