Provider Demographics
NPI:1356492086
Name:BRANDON NEPHROLOGY PA
Entity Type:Organization
Organization Name:BRANDON NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAPATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-8212
Mailing Address - Street 1:511 MEDICAL OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5961
Mailing Address - Country:US
Mailing Address - Phone:813-681-8212
Mailing Address - Fax:813-654-0478
Practice Address - Street 1:511 MEDICAL OAKS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5961
Practice Address - Country:US
Practice Address - Phone:813-681-8212
Practice Address - Fax:813-654-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2783Medicare ID - Type Unspecified