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NPI Code Detail

MEDICARE: KIDNEY INSTITUTE OF WISCONSIN, LLC

MEDICARE: KIDNEY INSTITUTE OF WISCONSIN, 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1831262674
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDNEY INSTITUTE OF WISCONSIN, LLC
Provider Business Mailing Address
First Line : 2100 CENTRAL AVE
Second Line : SUITE 201
City : BOULDER
State : CO
Zip : 80301-2838
Country : US
Telephone Number : 303-785-7523
Fax Number : 303-444-8639
Provider Business Practice Location Address
First Line : 5650 N GREEN BAY AVE
Second Line : SUITE 150
City : GLENDALE
State : WI
Zip : 53209-4446
Country : US
Telephone Number : 414-431-5960
Fax Number : 414-434-0359
Authorized Official
Title or Position : CFO
Name : HERBERT S LAWSON
Credential :
Telephone Number : 303-785-7521
Provider Enumeration Date : 11/17/2006
Last Update Date : 08/22/2020

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