Basic Information
| Provider Information | |||||||||
| NPI: | 1497705669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 CHERRY ST | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192514787 | ||||||||
| FaxNumber: | 4192516785 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 CHERRY ST | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192514787 | ||||||||
| FaxNumber: | 4192516785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAUREGUI | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4192514787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | CC3611 | 01 | OH | RAILROAD MEDICARE | OTHER |