Provider Demographics
NPI:1396782041
Name:INFECTIOUS DISEASE AND CONTROL CONSULTANTS LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE AND CONTROL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-932-5043
Mailing Address - Street 1:PO BOX 5043
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-5043
Mailing Address - Country:US
Mailing Address - Phone:870-932-5043
Mailing Address - Fax:870-932-5043
Practice Address - Street 1:2604 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4420
Practice Address - Country:US
Practice Address - Phone:870-932-5043
Practice Address - Fax:870-932-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3042207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F550Medicare ID - Type Unspecified