Organization
THE KIDNEY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABDEL FARID ABU SHAMAT M.D (MEMBER/PRESIDENT)
(337) 494-7090
Entity
Organization
Contact information
Practice address
333 DR MICHAEL DEBAKEY DR, SUITE 140, LAKE CHARLES, LA 70601-5887
(337) 494-7090
(337) 494-7040
Mailing address
PO BOX 3230, LAKE CHARLES, LA 70602-3230
(337) 494-7090
(337) 494-7040
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MD11617R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679232
—
LA
Enumeration date
12/07/2007
Last updated
12/07/2009
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