Provider Demographics
NPI:1699197921
Name:DIAB AGHA KIDNEY AND HYPERTENSION CLINIC INC
Entity Type:Organization
Organization Name:DIAB AGHA KIDNEY AND HYPERTENSION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-880-5553
Mailing Address - Street 1:6268 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1904
Mailing Address - Country:US
Mailing Address - Phone:954-880-5553
Mailing Address - Fax:954-208-4533
Practice Address - Street 1:6268 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1904
Practice Address - Country:US
Practice Address - Phone:954-880-5553
Practice Address - Fax:954-208-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty