Basic Information
| Provider Information | |||||||||
| NPI: | 1093483059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA KIDNEY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330717010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543454333 | ||||||||
| FaxNumber: | 9543454334 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330717010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543454333 | ||||||||
| FaxNumber: | 9543454334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2021 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | ELENA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4806106100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
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.