Provider Demographics
NPI:1841384005
Name:INFECTIOUS DISEASES ASSOCIATES OF NORTH FLORIDA, P.A.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES OF NORTH FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-819-9925
Mailing Address - Street 1:1093 A1A BEACH BLVD
Mailing Address - Street 2:PMB 415
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6733
Mailing Address - Country:US
Mailing Address - Phone:904-819-9925
Mailing Address - Fax:904-819-9926
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:SUITE 205
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-819-9925
Practice Address - Fax:904-819-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80064173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259185500Medicaid
FLH24561Medicare UPIN
FLK7712Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER