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General NPI Number Information
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NPI Number | 1073961843
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Entity Type | Organization
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Legal Business Name | KIDNEY DOCTORS OF KENTUCKIANA PLLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1035 WALL ST STE 103
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3695
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Country | US
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Telephone | 812-283-9111
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Fax | 812-283-9001
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Provider Business Mailing Address
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Address Line | PO BOX 950195
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City | LOUISVILLE
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State | KY
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Zip | 40295-0195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MUAD A MAYA
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Credential | MD
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Telephone | 812-283-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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