Provider Demographics
NPI:1265394712
Name:NEPHRONLIFE DIALYSIS LLC
Entity type:Organization
Organization Name:NEPHRONLIFE DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-797-7711
Mailing Address - Street 1:3001 S HARDIN BLVD STE 110-202
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7736
Mailing Address - Country:US
Mailing Address - Phone:469-797-7711
Mailing Address - Fax:214-491-5750
Practice Address - Street 1:2120 PRAIRIE DR BLDG UNIT1201
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3828
Practice Address - Country:US
Practice Address - Phone:469-797-7711
Practice Address - Fax:215-491-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty