Provider Demographics
NPI:1770538084
Name:INFECTIOUS DISEASE SPECIALISTS PC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-322-7250
Mailing Address - Street 1:210 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:SD
Mailing Address - Zip Code:57362-1414
Mailing Address - Country:US
Mailing Address - Phone:605-853-2786
Mailing Address - Fax:605-853-2653
Practice Address - Street 1:6709 S MINNESOTA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2592
Practice Address - Country:US
Practice Address - Phone:605-322-7250
Practice Address - Fax:605-322-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4997285OtherBCBS - GROUP
MN55G65ASOtherBCBS - GROUP
IA0569863Medicaid
ND12900Medicaid
SD4997285OtherBCBS - GROUP
IA0569863Medicaid
MN55G65ASOtherBCBS - GROUP