Healthcare Provider Details

I. General information

NPI: 1952308660
Provider Name (Legal Business Name): NEPHROLOGY & INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE OSCEOLA ST
STUART FL
34994-2364
US

IV. Provider business mailing address

500 SE OSCEOLA ST
STUART FL
34994-2364
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1555
  • Fax: 772-287-2140
Mailing address:
  • Phone: 772-286-1555
  • Fax: 772-287-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HARVEY B ULANO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 772-286-1555