Provider Demographics
NPI:1952076655
Name:FLORIDA KIDNEY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:FLORIDA KIDNEY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-610-6100
Mailing Address - Street 1:5730 BOWDEN RD
Mailing Address - Street 2:SUITE# 110
Mailing Address - City:BOWDEN
Mailing Address - State:FL
Mailing Address - Zip Code:33216
Mailing Address - Country:US
Mailing Address - Phone:904-388-2678
Mailing Address - Fax:904-388-6776
Practice Address - Street 1:5730 BOWDEN RD
Practice Address - Street 2:SUITE# 110
Practice Address - City:BOWDEN
Practice Address - State:FL
Practice Address - Zip Code:33216
Practice Address - Country:US
Practice Address - Phone:904-388-2678
Practice Address - Fax:904-388-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty