| NPI | 1043595291 |
|---|---|
| Former Legal Business Name | MD RENAL GROUP LLC |
| Entity Type | Organization |
| Authorized Contact | MAYRA I SANTIAGO Administrative Chief Officer 939-639-0557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: PR 17129) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2012-08-14 |