Provider Demographics
NPI:1134676026
Name:NORTH MIAMI KIDNEY CENTER, LLC
Entity Type:Organization
Organization Name:NORTH MIAMI KIDNEY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-600-4630
Mailing Address - Street 1:13930 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2908
Mailing Address - Country:US
Mailing Address - Phone:786-615-3430
Mailing Address - Fax:786-409-3134
Practice Address - Street 1:13930 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2908
Practice Address - Country:US
Practice Address - Phone:786-615-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019925300Medicaid