Provider Demographics
NPI:1164655189
Name:FLORIDA RENAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FLORIDA RENAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-314-3436
Mailing Address - Street 1:2810 W SAINT ISABEL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6375
Mailing Address - Country:US
Mailing Address - Phone:352-552-7832
Mailing Address - Fax:352-315-9197
Practice Address - Street 1:2810 W SAINT ISABEL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6375
Practice Address - Country:US
Practice Address - Phone:352-552-7832
Practice Address - Fax:352-315-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ189AMedicare UPIN