Provider Demographics
NPI:1295168144
Name:YOSEPH BIRKU INFECTIOUS DISEASES PC
Entity type:Organization
Organization Name:YOSEPH BIRKU INFECTIOUS DISEASES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-841-6470
Mailing Address - Street 1:12450 GREAT PARK CIR
Mailing Address - Street 2:UNIT 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5980
Mailing Address - Country:US
Mailing Address - Phone:414-841-6470
Mailing Address - Fax:
Practice Address - Street 1:12450 GREAT PARK CIR
Practice Address - Street 2:UNIT 102
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-5980
Practice Address - Country:US
Practice Address - Phone:414-841-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0075634207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I440857Medicare PIN