Healthcare Provider Details

I. General information

NPI: 1043126667
Provider Name (Legal Business Name): PALM BEACH KIDNEY SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 LAKE WORTH RD
GREENACRES FL
33463-3449
US

IV. Provider business mailing address

PO BOX 540292
GREENACRES FL
33454-0292
US

V. Phone/Fax

Practice location:
  • Phone: 561-709-8850
  • Fax:
Mailing address:
  • Phone: 347-392-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIE ANDRE
Title or Position: OWNER
Credential: MD
Phone: 347-392-7208