Organization
KIDNEY DISEASE CONSULTANTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUFEMI ADELEYE M.D. (PRESIDENT)
(901) 289-5206
Entity
Organization
Contact information
Practice address
1890 GOODMAN RD E, SUITE 101, SOUTHAVEN, MS 38671-9504
(662) 536-1859
Mailing address
PO BOX 366, SOUTHAVEN, MS 38671-0005
(662) 536-1859
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06530562
—
MS
01
—
231379826
BLUE CROSS
MS
05
—
3724848
—
TN
01
—
4093914
BCBS
TN
Enumeration date
02/08/2007
Last updated
04/03/2015
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