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General NPI Number Information
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NPI Number | 1790014017
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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 | 12/15/2009
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Last Update Date | 07/26/2010
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Provider Practice Location 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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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 | IFEANYI 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 | ME98154
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License Number State | FL
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