Provider Demographics
NPI:1871506543
Name:INFECTIOUS DISEASE ASSOCIATES LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:ADAMMA
Authorized Official - Last Name:OSONDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-206-0403
Mailing Address - Street 1:PO BOX 5921
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5921
Mailing Address - Country:US
Mailing Address - Phone:602-206-0403
Mailing Address - Fax:623-362-2954
Practice Address - Street 1:19841 N 27TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4003
Practice Address - Country:US
Practice Address - Phone:602-206-0403
Practice Address - Fax:623-362-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78702Medicare PIN