Basic Information
| Provider Information | |||||||||
| NPI: | 1346467628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOOSIER INFECTIOUS DISEASE CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 S STATE ROAD 135 STE D293 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461436561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176901733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 W JEFFERSON ST STE S | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463892 | ||||||||
| FaxNumber: | 3177453303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | BIRCH | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3176901733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 01043261A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.