Organization
COMPREHENSIVE KIDNEY DISEASE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMISH B SHAH M.D. (MANAGER)
(256) 489-3007
Entity
Organization
Contact information
Practice address
333 WHITESPORT DR SW, SUITE 205, HUNTSVILLE, AL 35801-6454
(256) 489-3007
(256) 489-3045
Mailing address
333 WHITESPORT DR SW, SUITE 205, HUNTSVILLE, AL 35801-6454
(256) 489-3007
(256) 489-3045
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
25611
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051519633SHA
MEDICARE ID TYPE UNSPECIFIED
—
Enumeration date
12/22/2010
Last updated
02/05/2011
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