Provider Demographics
NPI:1952410573
Name:FLORIDA INFECTIOUS DISEASE CONSULTANTS P.A
Entity Type:Organization
Organization Name:FLORIDA INFECTIOUS DISEASE CONSULTANTS P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOAIB
Authorized Official - Middle Name:ANWER
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-229-3505
Mailing Address - Street 1:10407 EMERALD WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5971
Mailing Address - Country:US
Mailing Address - Phone:321-229-3505
Mailing Address - Fax:407-386-9836
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE # 23
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-944-4900
Practice Address - Fax:407-483-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 75997207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL440002971OtherTRICARE
FL001634100Medicaid
FL258319400Medicaid
FL48924OtherBLUE CROSS BLUE SHIELD
FLH12602Medicare UPIN
FLK1656Medicare ID - Type Unspecified
FL001634100Medicaid