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General NPI Number Information
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NPI Number | 1265394712
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Entity Type | Organization
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Legal Business Name | NEPHRONLIFE DIALYSIS LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2120 PRAIRIE DR BLDG UNIT1201
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City | PROSPER
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State | TX
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Zip | 75078-3828
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Country | US
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Telephone | 469-797-7711
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Fax | 215-491-5750
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Provider Business Mailing Address
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Address Line | 3001 S HARDIN BLVD STE 110-202
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City | MCKINNEY
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State | TX
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Zip | 75070-7736
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Country | US
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Telephone | 469-797-7711
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Fax | 214-491-5750
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Authorized Official
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Title or Position | COO
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Name | DEEPAK CHANDRAMOHAN
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Credential | MD
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Telephone | 469-797-7711
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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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