Organization
KIDNEY INSTITUTE OF WISCONSIN, LLC
Active
Organization
KIDNEY INSTITUTE OF WISCONSIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT S LAWSON (CFO)
(303) 785-7521
Entity
Organization
Contact information
Practice address
5650 N GREEN BAY AVE, SUITE 150, GLENDALE, WI 53209-4446
(414) 431-5960
(414) 434-0359
Mailing address
2100 CENTRAL AVE, SUITE 201, BOULDER, CO 80301-2838
(303) 785-7523
(303) 444-8639
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
—
42059400
—
WI
Enumeration date
11/17/2006
Last updated
08/22/2020
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