Provider Demographics
NPI:1134465685
Name:H & Z RENAL CARE LLC
Entity Type:Organization
Organization Name:H & Z RENAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANJUM
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTESHAMUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-8158
Mailing Address - Street 1:52 TUSCAN WAY
Mailing Address - Street 2:SUITE 202 #350
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 TUSCAN WAY
Practice Address - Street 2:SUITE 202 #350
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1850
Practice Address - Country:US
Practice Address - Phone:646-331-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty