Basic Information
Provider Information | |||||||||
NPI: | 1568735058 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KIDNEY AND HYPERTENSION SPECIALISTS OF THE PALM BEACHES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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OtherOrganizationName: |   | ||||||||
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OtherMiddleName: |   | ||||||||
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OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1895 | ||||||||
Address2: |   | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334681895 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617482889 | ||||||||
FaxNumber: | 5617481523 | ||||||||
Practice Location | |||||||||
Address1: | 210 JUPITER LAKES BLVD | ||||||||
Address2: | SUITE 5203 | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334587191 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619728872 | ||||||||
FaxNumber: | 5617481523 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/15/2012 | ||||||||
LastUpdateDate: | 02/15/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARLOW | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER, JUPITER PROF DEVELOPMENT | ||||||||
AuthorizedOfficialTelephone: | 5617482889 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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NPICertificationDate: |   |
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.