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General NPI Number Information
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NPI Number | 1891866380
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Entity Type | Organization
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Legal Business Name | KIDNEY INSTITUTE OF WISCONSIN, LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10130 W APPLETON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53225-2579
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Country | US
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Telephone | 414-393-0600
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Fax | 414-393-0910
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Provider Business Mailing Address
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Address Line | 2100 CENTRAL AVE SUITE 201
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City | BOULDER
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State | CO
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Zip | 80301-2838
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Country | US
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Telephone | 303-785-7523
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Fax | 303-444-8639
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Authorized Official
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Title or Position | CFO
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Name | HERBERT S LAWSON
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Credential |
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Telephone | 303-785-7521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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