Provider Demographics
NPI:1134679293
Name:HYPERTENSION KIDNEY AND STONE CENTER, LLC
Entity Type:Organization
Organization Name:HYPERTENSION KIDNEY AND STONE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUTHALAKUZHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-724-3868
Mailing Address - Street 1:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2619
Mailing Address - Country:US
Mailing Address - Phone:813-724-3868
Mailing Address - Fax:813-724-3992
Practice Address - Street 1:12811 N NEBRASKA AVE STE I
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4401
Practice Address - Country:US
Practice Address - Phone:813-724-3868
Practice Address - Fax:813-724-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104902207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIT548AMedicare PIN