Provider Demographics
NPI:1508114141
Name:DELTA KIDNEY & HYPERTENSION, PLC
Entity Type:Organization
Organization Name:DELTA KIDNEY & HYPERTENSION, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NDIDI
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWAMU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-482-4101
Mailing Address - Street 1:7824 LAKE UNDERHILL RD
Mailing Address - Street 2:STE D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8201
Mailing Address - Country:US
Mailing Address - Phone:407-482-4101
Mailing Address - Fax:407-482-4157
Practice Address - Street 1:7824 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:407-482-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11673207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty