Provider Demographics
NPI:1942451380
Name:PD NEPHROLOGY LLC
Entity Type:Organization
Organization Name:PD NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-543-5235
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2173
Mailing Address - Country:US
Mailing Address - Phone:314-543-5235
Mailing Address - Fax:314-543-5216
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 103A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2173
Practice Address - Country:US
Practice Address - Phone:314-543-5235
Practice Address - Fax:314-543-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0921675261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment