MEDICARE: KIDNEY CONSULTANTS PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740206390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CONSULTANTS PC

Provider Business Mailing Address
First Line	:	PO BOX 5126
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5126
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:	605-373-9971

Provider Business Practice Location Address
First Line	:	911 E 20TH ST
Second Line	:	STE # 401
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1042
Country	:	US
Telephone Number	:	605-322-8290
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	MAZEN N NEMEH
Credential	:	MD
Telephone Number	:	605-322-8290

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/22/2013

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Directions to “KIDNEY CONSULTANTS PC ” Practice Location

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