Provider Demographics
NPI:1497919880
Name:FLORIDA KIDNEY DISEASE & HYPERTENSION CTR PA
Entity Type:Organization
Organization Name:FLORIDA KIDNEY DISEASE & HYPERTENSION CTR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKHANIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-505-8720
Mailing Address - Street 1:3221 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8002
Mailing Address - Country:US
Mailing Address - Phone:941-505-8720
Mailing Address - Fax:941-505-8747
Practice Address - Street 1:3221 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8002
Practice Address - Country:US
Practice Address - Phone:941-505-8720
Practice Address - Fax:941-505-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98038207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55659Medicare UPIN