Healthcare Provider Details

I. General information

NPI: 1245236876
Provider Name (Legal Business Name): CENTRAL FLORIDA KIDNEY CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S APOLLO BLVD
MELBOURNE FL
32901-3145
US

IV. Provider business mailing address

203 ERNESTINE STREET
ORLANDO FL
32801-3621
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-0431
  • Fax: 321-728-7562
Mailing address:
  • Phone: 407-843-6110
  • Fax: 407-425-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY KOZSUCH
Title or Position: CEO
Credential:
Phone: 407-843-6110