Provider Demographics
NPI:1023311990
Name:INFECTIOUS DISEASE PHYSICIANS OF DAYTON LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE PHYSICIANS OF DAYTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-885-0464
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-0652
Mailing Address - Country:US
Mailing Address - Phone:937-885-0464
Mailing Address - Fax:937-885-0464
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:INFUSION SERVICES
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-279-5803
Practice Address - Fax:937-279-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-3064207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty