Provider Demographics
NPI:1316130834
Name:KIDNEY ASSOCIATES OF SOUTHWEST LOUISIANA , L.L.C.
Entity type:Organization
Organization Name:KIDNEY ASSOCIATES OF SOUTHWEST LOUISIANA , L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU SHAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-439-5369
Mailing Address - Street 1:435 S RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5874
Mailing Address - Country:US
Mailing Address - Phone:337-439-5369
Mailing Address - Fax:337-436-9998
Practice Address - Street 1:435 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5874
Practice Address - Country:US
Practice Address - Phone:337-439-5369
Practice Address - Fax:337-436-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty