Organization
KIDNEY HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN T TUDOR MD (OWNER)
(407) 323-5047
Entity
Organization
Contact information
Practice address
2751 ENTERPRISE RD, SUITE 215, ORANGE CITY, FL 32763-8256
(407) 323-5047
(407) 323-5048
Mailing address
PO BOX 1881, SANFORD, FL 32772-1881
(407) 323-5047
(407) 323-5048
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME94020
FL
Other
Enumeration date
09/25/2013
Last updated
09/26/2013
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