Organization
INFECTIOUS DISEASES ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK MARK BERNSTEIN M.D. (OWNER)
(937) 572-7648
Entity
Organization
Contact information
Practice address
3533 SOUTHERN BLVD STE 4200, KETTERING, OH 45429-1272
(937) 572-7648
(937) 832-8279
Mailing address
3533 SOUTHERN BLVD STE 4200, KETTERING, OH 45429-1272
(937) 572-7648
(937) 832-8279
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
Primary
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2232597
—
OH
Enumeration date
05/18/2006
Last updated
03/15/2019
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