Provider Demographics
NPI:1093067530
Name:KIDNEY CARE OF MICHIANA LLC
Entity Type:Organization
Organization Name:KIDNEY CARE OF MICHIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHMIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-607-4724
Mailing Address - Street 1:3665 PARK PL W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3566
Mailing Address - Country:US
Mailing Address - Phone:574-607-4724
Mailing Address - Fax:
Practice Address - Street 1:3665 PARK PL W
Practice Address - Street 2:SUITE 300
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3566
Practice Address - Country:US
Practice Address - Phone:574-607-4724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty