Provider Demographics
NPI:1104189448
Name:KIDNEY DISEASE SPECIALIST PLLC
Entity Type:Organization
Organization Name:KIDNEY DISEASE SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:KASHIF
Authorized Official - Middle Name:MAJEED
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-943-2986
Mailing Address - Street 1:41750 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2679
Mailing Address - Country:US
Mailing Address - Phone:734-398-0444
Mailing Address - Fax:
Practice Address - Street 1:41750 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2679
Practice Address - Country:US
Practice Address - Phone:734-398-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077743207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty