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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