Provider Demographics
NPI:1669676383
Name:KIDNEY DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:KIDNEY DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-534-0861
Mailing Address - Street 1:47 CAVALIER BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3969
Mailing Address - Country:US
Mailing Address - Phone:859-534-0861
Mailing Address - Fax:859-534-0865
Practice Address - Street 1:47 CAVALIER BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3969
Practice Address - Country:US
Practice Address - Phone:859-534-0861
Practice Address - Fax:859-534-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100040200Medicaid
OH2843249Medicaid
OHKI9377261Medicare PIN
KY7100040200Medicaid