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General NPI Number Information
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NPI Number | 1689821241
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Entity Type | Organization
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Legal Business Name | KIDNEY CARE LLC
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 2200 N ALAFAYA TRL SUITE 600
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City | ORLANDO
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State | FL
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Zip | 32826-3993
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Country | US
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Telephone | 407-482-5588
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Fax | 407-358-5084
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Provider Business Mailing Address
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Address Line | 2200 N ALAFAYA TRL SUITE 600
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City | ORLANDO
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State | FL
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Zip | 32826-3993
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Country | US
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Telephone | 407-482-5588
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Fax | 407-358-5084
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Authorized Official
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Title or Position | SOLE MANAGER/OWNER
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Name | DR. AYAD SHUKUR
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Credential | MD
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Telephone | 407-473-8611
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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 | 93764
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License Number State | FL
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