Provider Demographics
NPI:1083635908
Name:KIDNEY CARE CONSULTANTS, PSC
Entity Type:Organization
Organization Name:KIDNEY CARE CONSULTANTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-238-9911
Mailing Address - Street 1:716 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2216
Mailing Address - Country:US
Mailing Address - Phone:502-238-9911
Mailing Address - Fax:502-238-9912
Practice Address - Street 1:716 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2216
Practice Address - Country:US
Practice Address - Phone:502-595-7744
Practice Address - Fax:502-595-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65938649Medicaid
IN200414260AMedicaid
KY7100371660Medicaid
KY7100371660Medicaid
IN200414260AMedicaid