Provider Demographics
NPI:1942587464
Name:INFECTIOUS DISEASES, PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AAMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-821-0900
Mailing Address - Street 1:330 1ST CAPITOL DR
Mailing Address - Street 2:#260
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2835
Mailing Address - Country:US
Mailing Address - Phone:314-821-0900
Mailing Address - Fax:800-556-8932
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:171B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-821-0900
Practice Address - Fax:800-556-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108767207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013458OtherMEDICARE GROUP PTAN