Basic Information
| Provider Information | |||||||||
| NPI: | 1760831564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA KIDNEY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12662 TELECOM DR | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Practice Location | |||||||||
| Address1: | 12662 TELECOM DR | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2016 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | UTTAMCHANDANI | ||||||||
| AuthorizedOfficialFirstName: | SHYAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D | ||||||||
| AuthorizedOfficialTelephone: | 8139108708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 07/13/2021 | ||||||||
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.