Provider Demographics
NPI:1013066281
Name:INFECTIOUS DISEASES CONSULTANTS OF CINCINNATI INC.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES CONSULTANTS OF CINCINNATI INC.
Other - Org Name:IDCC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-624-0999
Mailing Address - Street 1:330 STRAIGHT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1064
Mailing Address - Country:US
Mailing Address - Phone:513-624-0999
Mailing Address - Fax:513-624-0934
Practice Address - Street 1:330 STRAIGHT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1064
Practice Address - Country:US
Practice Address - Phone:513-624-0999
Practice Address - Fax:513-624-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RI0200X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH5059OtherGROUP RAILROAD MEDICARE
OH2201487Medicaid
OHCH5059OtherGROUP RAILROAD MEDICARE