Healthcare Provider Details

I. General information

NPI: 1033317433
Provider Name (Legal Business Name): A UNIQUE KIDNEY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N UNIVERSITY DR
DAVIE FL
33024-2234
US

IV. Provider business mailing address

10726 CHARLESTON PL
HOLLYWOOD FL
33026-4906
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-6080
  • Fax: 954-966-3656
Mailing address:
  • Phone: 954-438-6080
  • Fax: 954-499-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MANJIT SINGH GULATI
Title or Position: OWNER
Credential: MD
Phone: 954-438-6080