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General NPI Number Information
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NPI Number | 1942451380
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Entity Type | Organization
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Legal Business Name | PD NEPHROLOGY LLC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD SUITE 103A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2173
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Country | US
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Telephone | 314-543-5235
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Fax | 314-543-5216
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Provider Business Mailing Address
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Address Line | 10004 KENNERLY RD SUITE 103A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2173
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Country | US
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Telephone | 314-543-5235
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Fax | 314-543-5216
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NABIL TAUK
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Credential | M.D.
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Telephone | 314-543-5235
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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 | LC0921675
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License Number State | MO
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