Provider Demographics
NPI:1417269143
Name:KIDNEY SPECIALIST OF PALM BEACHES
Entity Type:Organization
Organization Name:KIDNEY SPECIALIST OF PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-283-0384
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4910
Mailing Address - Country:US
Mailing Address - Phone:561-283-0384
Mailing Address - Fax:
Practice Address - Street 1:11301 OKECHOBEE BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-283-0384
Practice Address - Fax:561-282-3238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDNEY SPECIALIST OF PALM BEACHES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87006207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94755Medicare PIN