Provider Demographics
NPI:1134260870
Name:KIDNEY DISEASE CONSULTANTS, P.C.
Entity type:Organization
Organization Name:KIDNEY DISEASE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-289-5206
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0005
Mailing Address - Country:US
Mailing Address - Phone:662-536-1859
Mailing Address - Fax:
Practice Address - Street 1:1890 GOODMAN RD E
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9504
Practice Address - Country:US
Practice Address - Phone:662-536-1859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724848Medicaid
MS231379826OtherBLUE CROSS
MS06530562Medicaid
TN4093914OtherBCBS
MSC03039Medicare PIN
MS231379826OtherBLUE CROSS