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Organization

MODESTO KIDNEY MEDICAL GROUP

Active
Other names
Itsara and Liu MD's
Organization subpart
No

Provider details

NPI number
Authorized official
LORI D MEISCHKE (BILLING MANAGER)
(541) 706-9073
Entity
Organization

Contact information

Practice address
305 E GRANGER AVE, STE 202, MODESTO, CA 95350-4344
(209) 526-1606
(209) 526-1677
Mailing address
305 E GRANGER AVE, SUITE 202, MODESTO, CA 95350-4345
(209) 526-1606
(209) 526-1677

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01031187 02
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0026660
CA
Enumeration date
06/01/2005
Last updated
03/29/2013
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