Provider Demographics
NPI:1841849098
Name:AUSTIN KIDNEY CARE LLC
Entity type:Organization
Organization Name:AUSTIN KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAEEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEEWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-538-2245
Mailing Address - Street 1:2005 PALO DURO RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-3242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 PALO DURO RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-3242
Practice Address - Country:US
Practice Address - Phone:617-538-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty