MEDICARE: KIDNEY & DIALYSIS SPECIALISTS OF THE PALM BEACHES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME75515	FL

General Provider Information

NPI Number	:	1033169107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY & DIALYSIS SPECIALISTS OF THE PALM BEACHES, PA

Provider Business Mailing Address
First Line	:	5305 GREENWOOD AVE STE 102
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2448
Country	:	US
Telephone Number	:	561-840-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 GREENWOOD AVE STE 102
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2448
Country	:	US
Telephone Number	:	561-840-7779
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MICHELLE KATHERINE GAMMACK-CLARK
Credential	:
Telephone Number	:	561-840-7779

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	09/14/2023

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