Provider Demographics
NPI:1598015323
Name:WEST BROWARD NEPHROLOGY PA
Entity Type:Organization
Organization Name:WEST BROWARD NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOURGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-739-2221
Mailing Address - Street 1:2951 NW 49TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1617
Mailing Address - Country:US
Mailing Address - Phone:954-739-2221
Mailing Address - Fax:954-739-2271
Practice Address - Street 1:2951 NW 49TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1617
Practice Address - Country:US
Practice Address - Phone:954-739-2221
Practice Address - Fax:954-739-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID