Provider Demographics
NPI:1922032994
Name:INFECTIOUS DISEASE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS, INC.
Other - Org Name:DR. MANIAN, DR. JANSSEN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARRIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:314-251-5700
Mailing Address - Street 1:621 S NEW BALLAS RD STE 70B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8251
Mailing Address - Country:US
Mailing Address - Phone:314-251-5700
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 70B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8251
Practice Address - Country:US
Practice Address - Phone:314-251-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F74207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000012024Medicare PIN