Provider Demographics
NPI:1861681298
Name:AKDHC, LLC
Entity Type:Organization
Organization Name:AKDHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:602-351-3015
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2926
Mailing Address - Country:US
Mailing Address - Phone:602-351-3015
Mailing Address - Fax:
Practice Address - Street 1:3003 N CENTRAL AVE STE T100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2929
Practice Address - Country:US
Practice Address - Phone:602-263-5446
Practice Address - Fax:602-263-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28479Medicare PIN