Basic Information
| Provider Information | |||||||||
| NPI: | 1538771803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASE MEDICAL CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5258 LINTON BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614957570 | ||||||||
| FaxNumber: | 5614967074 | ||||||||
| Practice Location | |||||||||
| Address1: | 5258 LINTON BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614957570 | ||||||||
| FaxNumber: | 5614967074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2020 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOMAIHA | ||||||||
| AuthorizedOfficialFirstName: | HAMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5614957570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/18/2020 | ||||||||
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.