Healthcare Provider Details

I. General information

NPI: 1548975873
Provider Name (Legal Business Name): EPSILON KIDNEY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 WOODMERE BLVD STE C4
MONTGOMERY AL
36106-3083
US

IV. Provider business mailing address

PO BOX 33157
BELFAST ME
04915-0609
US

V. Phone/Fax

Practice location:
  • Phone: 888-867-9799
  • Fax: 833-841-0400
Mailing address:
  • Phone: 888-867-9799
  • Fax: 833-841-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STELLA AWUA-LARBI
Title or Position: OWNER
Credential: MD
Phone: 630-210-2550