Provider Demographics
NPI:1356582506
Name:CENTRAL CAROLINA KIDNEY ASSOCIATES PA
Entity type:Organization
Organization Name:CENTRAL CAROLINA KIDNEY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNSOOR
Authorized Official - Middle Name:N
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-584-4913
Mailing Address - Street 1:2903 PROFESSIONAL PARK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9388
Mailing Address - Country:US
Mailing Address - Phone:336-584-4913
Mailing Address - Fax:336-584-4914
Practice Address - Street 1:2903 PROFESSIONAL PARK RD
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9388
Practice Address - Country:US
Practice Address - Phone:336-584-4913
Practice Address - Fax:336-584-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty