Provider Demographics
NPI:1336382860
Name:INTERNAL MEDICINE & KIDNEY ASSOCIATES PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & KIDNEY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAWEH
Authorized Official - Middle Name:DARDWAH
Authorized Official - Last Name:BEYSOLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-293-5015
Mailing Address - Street 1:1111 12TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4087
Mailing Address - Country:US
Mailing Address - Phone:305-293-5015
Mailing Address - Fax:305-293-5016
Practice Address - Street 1:1111 12TH ST STE 108
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4087
Practice Address - Country:US
Practice Address - Phone:305-293-5015
Practice Address - Fax:305-293-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000835400Medicaid