Provider Demographics
NPI:1790014017
Name:LIVING STONE NEPHROLOGY AND HYPERTENSION CONSULTANTS INC
Entity Type:Organization
Organization Name:LIVING STONE NEPHROLOGY AND HYPERTENSION CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-438-8085
Mailing Address - Street 1:17901 NW 5TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-438-8085
Mailing Address - Fax:954-438-8086
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-438-8085
Practice Address - Fax:954-438-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98154207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty