Provider Demographics
NPI:1174649354
Name:KIDNEY AND HYPERTENSION SPECIALISTS PLLC
Entity Type:Organization
Organization Name:KIDNEY AND HYPERTENSION SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REDDIVALEM
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:NAGESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-788-7866
Mailing Address - Street 1:900 E MICHIGAN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2457
Mailing Address - Country:US
Mailing Address - Phone:517-788-7866
Mailing Address - Fax:517-796-9339
Practice Address - Street 1:900 E MICHIGAN AVE
Practice Address - Street 2:STE 104
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2457
Practice Address - Country:US
Practice Address - Phone:517-788-7866
Practice Address - Fax:517-796-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRN042337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty