Healthcare Provider Details

I. General information

NPI: 1174009344
Provider Name (Legal Business Name): KIDNEY AND HYPERTENSION OF THE PALM BEACHES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JOHN F KENNEDY DR
ATLANTIS FL
33462-1119
US

IV. Provider business mailing address

101 JOHN F KENNEDY DR
ATLANTIS FL
33462-1119
US

V. Phone/Fax

Practice location:
  • Phone: 561-612-8080
  • Fax: 561-612-8084
Mailing address:
  • Phone: 561-612-8080
  • Fax: 561-612-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME114122
License Number StateFL

VIII. Authorized Official

Name: YEHIA ABDELWAHED
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 561-612-8080