Provider Demographics
NPI:1033658174
Name:KIDNEY CARE OF DALLAS PLLC
Entity Type:Organization
Organization Name:KIDNEY CARE OF DALLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-397-7789
Mailing Address - Street 1:10611 GARLAND RD, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2680
Mailing Address - Country:US
Mailing Address - Phone:713-397-7789
Mailing Address - Fax:817-622-8068
Practice Address - Street 1:10611 GARLAND RD STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2680
Practice Address - Country:US
Practice Address - Phone:713-397-7789
Practice Address - Fax:817-622-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2822207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty