| NPI | 1346019676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE BOUCKENOOGHE Billing And Credentialing 727-207-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2026-02-10 |