Healthcare Provider Details

I. General information

NPI: 1497919880
Provider Name (Legal Business Name): FLORIDA KIDNEY DISEASE & HYPERTENSION CTR PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 TAMIAMI TRL
PORT CHARLOTTE FL
33952-8002
US

IV. Provider business mailing address

3221 TAMIAMI TRL
PORT CHARLOTTE FL
33952-8002
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-8720
  • Fax: 941-505-8747
Mailing address:
  • Phone: 941-505-8720
  • Fax: 941-505-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME98038
License Number StateFL

VIII. Authorized Official

Name: ROHIT PANKHANIYA
Title or Position: OWNER
Credential: MD
Phone: 941-505-8720