Provider Demographics
NPI:1467127472
Name:KIDNEY CARE CONSULTANTS PLLC
Entity Type:Organization
Organization Name:KIDNEY CARE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAUSHABA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-559-0505
Mailing Address - Street 1:17177 N LAUREL PARK DR STE 439
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3938
Mailing Address - Country:US
Mailing Address - Phone:734-462-0340
Mailing Address - Fax:734-462-0344
Practice Address - Street 1:32121 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0999
Practice Address - Country:US
Practice Address - Phone:248-690-9946
Practice Address - Fax:248-268-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679749626Medicaid