Provider Demographics
NPI:1770731549
Name:OHIO INFECTIOUS DISEASE CONSULTANTS, P.C., INC.
Entity type:Organization
Organization Name:OHIO INFECTIOUS DISEASE CONSULTANTS, P.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDATHIRU
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-225-5010
Mailing Address - Street 1:5270 CROFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1277
Mailing Address - Country:US
Mailing Address - Phone:216-225-5010
Mailing Address - Fax:440-498-0217
Practice Address - Street 1:5270 CROFTON AVENUE
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1277
Practice Address - Country:US
Practice Address - Phone:216-225-5010
Practice Address - Fax:440-498-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 083003207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770731549OtherNPI
OH2920978Medicaid
OH35 083003OtherOHIO MEDICAL LICENSE
OH9378371Medicare PIN