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General NPI Number Information
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NPI Number | 1558667949
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Entity Type | Organization
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Legal Business Name | KIDNEY SPECIALIST
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 508 E ALMOND AVE
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City | MADERA
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State | CA
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Zip | 93637-5611
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Country | US
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Telephone | 559-661-1965
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Fax | 559-661-1952
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Provider Business Mailing Address
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Address Line | PO BOX 180
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City | MADERA
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State | CA
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Zip | 93639-0180
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Country | US
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Telephone | 559-661-1965
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Fax | 559-661-1952
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Authorized Official
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Title or Position | NEPHROLOGIST
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Name | DR. SHEIKH MOHAMMAD MASOOD
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Credential | M.D.
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Telephone | 559-661-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C52769
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License Number State | CA
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