Provider Demographics
NPI:1093264558
Name:KIDNEY PLUS PLLC
Entity Type:Organization
Organization Name:KIDNEY PLUS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUR
Authorized Official - Middle Name:RAHMAN
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-800-0953
Mailing Address - Street 1:3810 HOLLYWOOD BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6779
Mailing Address - Country:US
Mailing Address - Phone:954-800-0953
Mailing Address - Fax:954-800-0956
Practice Address - Street 1:3810 HOLLYWOOD BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6779
Practice Address - Country:US
Practice Address - Phone:954-800-0953
Practice Address - Fax:954-800-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114665207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019780300Medicaid
FLDCM9MOtherFLORIDA BLUE