Provider Demographics
NPI:1548904238
Name:KIDNEY INSTITUTE OF MIAMI LLC
Entity type:Organization
Organization Name:KIDNEY INSTITUTE OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-644-2212
Mailing Address - Street 1:PO BOX 524102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33152-4102
Mailing Address - Country:US
Mailing Address - Phone:305-644-2212
Mailing Address - Fax:786-475-7787
Practice Address - Street 1:5040 NW 7TH ST STE 635
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3796
Practice Address - Country:US
Practice Address - Phone:305-644-2212
Practice Address - Fax:786-475-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1679912117OtherNPPES