MEDICARE: CFA KIDNEY & HYPERTENSION CENTER LLC

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	261Q00000X	Clinic/Center	L06000028969	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DF1497	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14479901	OTHER		CITRUS HEALTH CARE PLAN
2	7281278	OTHER		CIGNA
4	56284	OTHER	FL	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	303267	OTHER		AVMED
7	354671	OTHER	FL	WELLCARE

General Provider Information

NPI Number	:	1538198783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CFA KIDNEY & HYPERTENSION CENTER LLC

Provider Business Mailing Address
First Line	:	P O BOX 915467
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32791-5467
Country	:	US
Telephone Number	:	321-214-4133
Fax Number	:	321-214-4216

Provider Business Practice Location Address
First Line	:	587 E STATE ROAD 434
Second Line	:	SUITE 1011
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5284
Country	:	US
Telephone Number	:	321-214-4133
Fax Number	:	321-214-4216

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLUFUNMILOLA OLUWAKEMI DARAMOLA-OGUNWUYI
Credential	:	MD
Telephone Number	:	321-214-4133

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	03/03/2011

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Directions to “CFA KIDNEY & HYPERTENSION CENTER LLC ” Practice Location

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