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General NPI Number Information
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NPI Number | 1508687229
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Entity Type | Organization
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Legal Business Name | INTERWELL HEALTH MEDICAL PRACTICE OF KANSAS LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 68 HARRISON AVE STE 39516
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 833-664-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 68 HARRISON AVE STE 605 PMB 39516
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 833-664-8244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE DOMINGUEZ
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Credential | MD
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Telephone | 833-644-8244
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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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