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General NPI Number Information
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NPI Number | 1134679293
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Entity Type | Organization
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Legal Business Name | HYPERTENSION KIDNEY AND STONE CENTER, LLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 5344 9TH ST STE 107
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-4348
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Country | US
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Telephone | 813-724-3868
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Fax | 813-724-3992
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Provider Business Mailing Address
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Address Line | PO BOX 2619
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City | ZEPHYRHILLS
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State | FL
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Zip | 33539-2619
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Country | US
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Telephone | 813-724-3868
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Fax | 813-724-3992
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Authorized Official
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Title or Position | PRESIDENT/PROVIDER
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Name | GEORGE S MUTHALAKUZHY
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Credential | MD
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Telephone | 813-724-3868
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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 | ME104902
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License Number State | FL
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