Organization
BREVARD KIDNEY & HYPERTENSION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUKON K WANICH MD (ADMINISTRATOR)
(321) 452-0020
Entity
Organization
Contact information
Practice address
245 S COURTENAY PKWY, BLDG A, MERRITT ISLAND, FL 32952
(321) 452-0020
(321) 453-4366
Mailing address
245 S COURTENAY PKWY, BLDG A, MERRITT ISLAND, FL 32952
(321) 452-0020
(321) 453-4366
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V78
BCBS OF FL
FL
Enumeration date
10/19/2006
Last updated
08/22/2020
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