Healthcare Provider Details

I. General information

NPI: 1699729061
Provider Name (Legal Business Name): RENAL INTERVENTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE
AKRON OH
44307-2433
US

IV. Provider business mailing address

PO BOX 73405
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-7274
  • Fax:
Mailing address:
  • Phone: 888-719-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMI GREEN
Title or Position: CLIENT REPRESENTATIVE
Credential:
Phone: 330-493-9004