# MID OHIO INFECTIOUS DISEASES CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164652822
- **Authorized official:** DR. UCHENNA A EZIKE MD (OWNER/PRESIDENT)
- **Authorized official phone:** (412) 708-1608

## Contact information

- **Practice address:** 630 LEXINGTON AVE, MANSFIELD, OH 44907-1500
- **Practice address phone:** (412) 708-1608
- **Mailing address:** PO BOX 5096, MANSFIELD, OH 44901-5096

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 35093594 | OH | Yes |

## Other

- **Enumeration date:** 07/16/2009
- **Last updated:** 07/16/2009