Provider Demographics
NPI:1093988719
Name:SOUTH FLORIDA KIDNEY ASSOCIATES PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA KIDNEY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:F
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-885-1024
Mailing Address - Street 1:17913 NW 7TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2811
Mailing Address - Country:US
Mailing Address - Phone:954-885-1024
Mailing Address - Fax:954-885-1340
Practice Address - Street 1:17913 NW 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2811
Practice Address - Country:US
Practice Address - Phone:954-885-1024
Practice Address - Fax:954-885-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE60459Medicare UPIN