Provider Demographics
NPI:1538289897
Name:ORTIZ-KIDD, ENRIQUE O (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:O
Last Name:ORTIZ-KIDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CALLE LIMONCILLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6603
Mailing Address - Country:US
Mailing Address - Phone:787-746-7441
Mailing Address - Fax:
Practice Address - Street 1:85 CALLE LIMONCILLO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6603
Practice Address - Country:US
Practice Address - Phone:787-746-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6477207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77645Medicare UPIN
PR0028726Medicare PIN