Provider Demographics
NPI:1861688004
Name:KISSIMMEE NEPHROLOGY & HYPERTENSION, PA
Entity Type:Organization
Organization Name:KISSIMMEE NEPHROLOGY & HYPERTENSION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-5080
Mailing Address - Street 1:2220 E IRLO BRONSON HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5312
Mailing Address - Country:US
Mailing Address - Phone:407-847-0019
Mailing Address - Fax:407-518-0119
Practice Address - Street 1:2220 E IRLO BRONSON HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5312
Practice Address - Country:US
Practice Address - Phone:407-847-0019
Practice Address - Fax:407-518-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003858275OtherINDIVIDUAL NPI #
FL1386747798OtherINDIVIDUAL NPI #
FL44193ZOtherINDIVIDUAL MC PROVIDER #
FLAC951ZOtherINDIVIDUAL MC PROVIDER #
FLAC951ZOtherINDIVIDUAL MC PROVIDER #
FL1386747798OtherINDIVIDUAL NPI #