Provider Demographics
NPI:1932693884
Name:MIDWEST INFECTIOUS DISEASES ASSOCIATES LLC
Entity Type:Organization
Organization Name:MIDWEST INFECTIOUS DISEASES ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-895-1185
Mailing Address - Street 1:53 W TAM O SHANTER DR
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-6302
Mailing Address - Country:US
Mailing Address - Phone:708-334-9738
Mailing Address - Fax:708-672-9768
Practice Address - Street 1:751 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5538
Practice Address - Country:US
Practice Address - Phone:219-895-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042402207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1578637245OtherNPI