Provider Demographics
NPI:1760831564
Name:FLORIDA KIDNEY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:FLORIDA KIDNEY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:UTTAMCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-910-8708
Mailing Address - Street 1:12662 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0935
Mailing Address - Country:US
Mailing Address - Phone:813-910-8708
Mailing Address - Fax:855-852-7153
Practice Address - Street 1:12662 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0935
Practice Address - Country:US
Practice Address - Phone:813-910-8708
Practice Address - Fax:855-852-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty