Provider Demographics
NPI:1598407207
Name:INFIGO DIALYSIS LLC
Entity type:Organization
Organization Name:INFIGO DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:SAYED
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-364-0728
Mailing Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:321-364-0728
Mailing Address - Fax:321-364-0729
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:321-364-0728
Practice Address - Fax:321-364-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME128664OtherCOMMERCIAL
FLME128664Medicaid