Provider Demographics
NPI:1073702601
Name:RENAL MD LLC
Entity Type:Organization
Organization Name:RENAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:JULKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-373-5539
Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:BUILDING 3 SUITE 7
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-373-5539
Mailing Address - Fax:504-373-6151
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:BUILDING 3 SUITE 7
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-373-5539
Practice Address - Fax:504-373-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10332R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1986224Medicaid
LAC88202Medicare UPIN
LA5CG73Medicare PIN