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General NPI Number Information
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NPI Number | 1639594211
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Entity Type | Organization
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Legal Business Name | LIVING STONE NEPHROLOGY AND HYPERTENSION CONSULTANTS, INC.
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 17325 NW 27TH AVE SUITE 108
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-4056
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Country | US
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Telephone | 954-438-8085
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Fax | 954-438-8086
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Provider Business Mailing Address
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Address Line | 17901 NW 5TH ST SUITE 203
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2810
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Country | US
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Telephone | 954-438-8085
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Fax | 954-438-8086
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Authorized Official
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Title or Position | OWNER
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Name | DR. IFEANYI O ISAIAH
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Credential | MD
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Telephone | 954-438-8085
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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 | ME 98154
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License Number State | FL
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