Basic Information
| Provider Information | |||||||||
| NPI: | 1003440439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROCARE DIALYSIS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23010 SHERIDAN ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481281837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136088068 | ||||||||
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| Practice Location | |||||||||
| Address1: | GARDEN CITY HOSPTIAL | ||||||||
| Address2: | 6245 INKSTER ROAD | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344583300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2020 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAAD | ||||||||
| AuthorizedOfficialFirstName: | CHADI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3136088068 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.