Provider Demographics
NPI:1962467373
Name:GULF COAST KIDNEY ASSOCIATES, PL
Entity Type:Organization
Organization Name:GULF COAST KIDNEY ASSOCIATES, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-917-8722
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-8722
Mailing Address - Fax:941-917-8727
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-8722
Practice Address - Fax:941-917-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254520001Medicaid
FL254542000Medicaid
FL38341OtherBCBS
FL38341OtherBCBS
FLK3580Medicare PIN