Provider Demographics
NPI:1689821241
Name:KIDNEY CARE LLC
Entity type:Organization
Organization Name:KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-473-8611
Mailing Address - Street 1:2200 N ALAFAYA TRL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3993
Mailing Address - Country:US
Mailing Address - Phone:407-482-5588
Mailing Address - Fax:407-358-5084
Practice Address - Street 1:2200 N ALAFAYA TRL
Practice Address - Street 2:SUITE 600
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3993
Practice Address - Country:US
Practice Address - Phone:407-482-5588
Practice Address - Fax:407-358-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93764207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty