Basic Information
| Provider Information | |||||||||
| NPI: | 1104193754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ID CONSULTANT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4015 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376024015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239151126 | ||||||||
| FaxNumber: | 4239150635 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 TUSCULUM BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377454279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237836400 | ||||||||
| FaxNumber: | 4237875146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2011 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | HIREN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4239434030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.