Organization
KIDNEY INSTITUTE OF NAPLES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S RUSSO MD, PHD (OWNER)
(239) 513-1002
Entity
Organization
Contact information
Practice address
878 109TH AVE N, NAPLES, FL 34108-1821
(239) 596-3044
Mailing address
878 109TH AVE NO, NAPLES, FL 34108-1821
(239) 596-3044
(239) 596-1395
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
—
892063000
—
FL
Enumeration date
06/26/2006
Last updated
10/25/2010
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