Organization
JACKSONVILLE KIDNEY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOTESWARI KANCHA MD (PRESIDENT)
(904) 647-8207
Entity
Organization
Contact information
Practice address
13241 BARTRAM PARK BLVD UNIT 409, JACKSONVILLE, FL 32258-5237
(904) 400-6800
Mailing address
10036 DEERCREEK CLUB RD E, JACKSONVILLE, FL 32256-1457
(904) 402-5137
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME 98954
FL
Other
Enumeration date
08/25/2010
Last updated
12/08/2016
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