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General NPI Number Information
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NPI Number | 1366006967
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Entity Type | Organization
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Legal Business Name | FLORIDA NEPHROLOGY HYPERTENSION & RENAL TRANSPLANTATION, LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 4355 BEAR GULLY RD STE 1024
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City | WINTER PARK
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State | FL
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Zip | 32792-9422
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Country | US
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Telephone | 407-647-2550
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Fax | 407-647-0616
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Provider Business Mailing Address
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Address Line | 5745 CANTON CV STE 121
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-5012
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Country | US
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Telephone | 407-288-8750
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Fax | 407-412-7387
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Authorized Official
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Title or Position | OWNER/ OPERATOR
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Name | IJLAL UDDIN
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Credential | MD
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Telephone | 407-647-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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