Provider Demographics
NPI:1881769685
Name:ORLANDO INFECTIOUS DISEASE CONSULTANCY SERVICES PL
Entity type:Organization
Organization Name:ORLANDO INFECTIOUS DISEASE CONSULTANCY SERVICES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ESAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-350-5917
Mailing Address - Street 1:4156 BROOKMYRA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5109
Mailing Address - Country:US
Mailing Address - Phone:321-228-0073
Mailing Address - Fax:407-350-5928
Practice Address - Street 1:1182 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-350-5917
Practice Address - Fax:407-350-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88164207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268403900Medicaid
FLDF5048OtherRAILROAD MEDICARE
FLDF5048OtherRAILROAD MEDICARE
FLAB254Medicare PIN