Provider Demographics
NPI:1003809948
Name:KIDNEY INSTITUTE OF NORTH DAKOTA, LLC
Entity Type:Organization
Organization Name:KIDNEY INSTITUTE OF NORTH DAKOTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:RABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-795-1300
Mailing Address - Street 1:1451 - 44TH AVENUE SOUTH SUITE 112-D
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4055
Mailing Address - Country:US
Mailing Address - Phone:701-795-1300
Mailing Address - Fax:701-775-5200
Practice Address - Street 1:1451 - 44TH AVENUE SOUTH SUITE 112-D
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4055
Practice Address - Country:US
Practice Address - Phone:701-795-1300
Practice Address - Fax:701-775-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01574Medicaid
MN899627000Medicaid
ND352501Medicare Oscar/Certification