Basic Information
| Provider Information | |||||||||
| NPI: | 1063715407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINELLAS INFECTIOUS DISEASE PHYSICIANS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1753 BELLEAIR FOREST DR | ||||||||
| Address2: | APT D-4 | ||||||||
| City: | BELLEAIR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337567752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186661703 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 PINELLAS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274627000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHAIKH | ||||||||
| AuthorizedOfficialFirstName: | ZAHIRABANU | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7186661703 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | ME99036 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | ME 99036 | 01 | FL | MEDICAL LICENSE | OTHER |