Provider Demographics
NPI:1083876619
Name:RENAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:RENAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-3456
Mailing Address - Street 1:1580 VALENCIA ST
Mailing Address - Street 2:STE 806
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4423
Mailing Address - Country:US
Mailing Address - Phone:415-647-6660
Mailing Address - Fax:415-647-8339
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:STE 806
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-647-6660
Practice Address - Fax:415-647-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A517650Medicaid
CAA997520OtherSTATE LICENSE
CAG623550OtherSTATE LICENSE
CA00G623551Medicaid
CA1891860193OtherNPI
CAA517650OtherSTATE LICENSE
CA00A997520Medicaid
CA1457317729OtherNPI
CA1336214634OtherNPI
CAG623550OtherSTATE LICENSE
CA1457317729OtherNPI
CA00A517651Medicare PIN