Provider Demographics
NPI:1760702393
Name:ALL KIDNEY CARE PA
Entity Type:Organization
Organization Name:ALL KIDNEY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SREELATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-342-2544
Mailing Address - Street 1:6001 PALM PLACE LN
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2690
Mailing Address - Country:US
Mailing Address - Phone:352-342-2544
Mailing Address - Fax:813-442-7735
Practice Address - Street 1:4543 S MANHATTAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2330
Practice Address - Country:US
Practice Address - Phone:813-831-8888
Practice Address - Fax:813-831-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95844261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty