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Organization
CAROLINA DIABETES & KIDNEY CENTER, LLC
Active
Organization
CAROLINA DIABETES & KIDNEY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. USAH LILAVIVAT MD (PRESIDENT)
(803) 469-7950
Entity
Organization
Contact information
Practice address
625 W WESMARK BLVD, SUMTER, SC 29150-1900
(803) 469-7950
(803) 469-7548
Mailing address
625 W WESMARK BLVD, SUMTER, SC 29150-1900
(803) 469-7950
(803) 469-7548
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
207RH0005X
Hypertension Specialist Physician
—
NULL
207RH0005X
Hypertension Specialist Physician
—
—
207RI0200X
Infectious Disease Physician
—
NULL
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
NULL
207RN0300X
Nephrology Physician
—
—
207RR0500X
Rheumatology Physician
—
NULL
207RR0500X
Rheumatology Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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