Healthcare Provider Details

I. General information

NPI: 1255833844
Provider Name (Legal Business Name): KIDNEY CARE OF KENDALL DIALYSIS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 S.W. 136TH STREET 210
MIAMI FL
33186
US

IV. Provider business mailing address

13501 S.W. 136TH STREET 210
MIAMI FL
33186
US

V. Phone/Fax

Practice location:
  • Phone: 305-318-3169
  • Fax: 305-623-7880
Mailing address:
  • Phone: 305-318-3169
  • Fax: 305-623-7880

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 State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FREDDIE MISENAS
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 305-318-3169