Healthcare Provider Details

I. General information

NPI: 1366006967
Provider Name (Legal Business Name): FLORIDA NEPHROLOGY HYPERTENSION & RENAL TRANSPLANTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 BEAR GULLY RD STE 1024
WINTER PARK FL
32792-9422
US

IV. Provider business mailing address

5745 CANTON CV STE 121
WINTER SPRINGS FL
32708-5012
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2550
  • Fax: 407-647-0616
Mailing address:
  • Phone: 407-288-8750
  • Fax: 407-412-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IJLAL UDDIN
Title or Position: OWNER/ OPERATOR
Credential: MD
Phone: 407-647-2550