Organization
MEDICINE AND NEPHROLOGY CLINIC LLC
Active
Organization
MEDICINE AND NEPHROLOGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NDUBUEZE FIDELIS OKONKWO M.D (OWNER)
(316) 452-5455
Entity
Organization
Contact information
Practice address
700 W CENTRAL AVE STE 206, EL DORADO, KS 67042-2186
(316) 452-5455
(316) 321-0503
Mailing address
700 W CENTRAL AVE STE 206, EL DORADO, KS 67042-2186
(316) 452-5455
(316) 321-0503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RN0300X
Nephrology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972118
—
LA
Enumeration date
10/21/2016
Last updated
11/01/2016
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