Provider Demographics
NPI:1891957429
Name:RENAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:RENAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-3456
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:STE 412
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3815
Mailing Address - Fax:415-749-5713
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:STE 405
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3456
Practice Address - Fax:415-923-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457317729OtherNPI
CAA997520OtherSTATE LICENSE
CA1619040227OtherNPI
CAA52155OtherSTATE LICENSE
CA00A997520Medicaid
CA00A521550Medicaid
CA1619040227OtherNPI
CA00A997520Medicare PIN