Provider Demographics
NPI:1255958500
Name:CLEVELAND KIDNEY CARE, LLC
Entity type:Organization
Organization Name:CLEVELAND KIDNEY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSIM
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:EL-HITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-401-8323
Mailing Address - Street 1:5 ELEVEN RIV
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1777
Mailing Address - Country:US
Mailing Address - Phone:216-401-8323
Mailing Address - Fax:
Practice Address - Street 1:5 ELEVEN RIV
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1777
Practice Address - Country:US
Practice Address - Phone:216-401-8323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty