| Infectious Disease Consultants Medical Group | |
|
201 S Buena Vista St Ste 440 Burbank CA 91505-4577 | |
| (818) 500-0935 | |
| (818) 500-0728 |
| Full Name | Infectious Disease Consultants Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 201 S Buena Vista St Ste 440, Burbank, California |
| Authorized Official Name and Position | John Williston Harris (MANAGING PARTNER) |
| Authorized Official Contact | 8185000935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Consultants Medical Group 201 S Buena Vista St Ste 440 Burbank CA 91505-4577 Ph: (818) 500-0935 | Infectious Disease Consultants Medical Group 201 S Buena Vista St Ste 440 Burbank CA 91505-4577 Ph: (818) 500-0935 |
| NPI Number | 1013947712 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 07/29/2019 |
| Medicare PECOS PAC ID | 6204723935 |
|---|---|
| Medicare Enrollment ID | O20040227001008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013947712 | NPI | - | NPPES |
| GR0007180 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Karen L Tsujimoto |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1174598122 PECOS PAC ID: 2567350168 Enrollment ID: I20040305000788 |
| Provider Name | John W Harris |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1356648703 PECOS PAC ID: 8123271426 Enrollment ID: I20150914000554 |
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