Organization
KIDNEY INSTITUTE CENTER OF EXCELLENCE, LLC
Active
Organization
KIDNEY INSTITUTE CENTER OF EXCELLENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUNE A. CLARK (BUSINESS MANAGER)
(727) 733-2040
Entity
Organization
Contact information
Practice address
601 N 99TH ST, SUITE 100, WAUWATOSA, WI 53226-4339
(414) 755-6300
Mailing address
1964 BAYSHORE BLVD, STE C, DUNEDIN, FL 34698-2576
(727) 733-2040
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
05
—
42061900
—
WI
Enumeration date
03/07/2006
Last updated
05/22/2008
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