Healthcare Provider Details

I. General information

NPI: 1801684543
Provider Name (Legal Business Name): KENDALL KIDNEY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 88TH ST STE 165
MIAMI FL
33186-1550
US

IV. Provider business mailing address

700 TAMARACK RD
STOWE VT
05672-4206
US

V. Phone/Fax

Practice location:
  • Phone: 305-388-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT CRAWFORD
Title or Position: PRESIDENT
Credential: DVM
Phone: 508-944-6304