| Gulf Coast Kidney Associates, Pl | |
|
1921 Waldemere St Suite 306 Sarasota FL 34239-2943 | |
| (941) 917-8722 | |
| (941) 917-8727 |
| Full Name | Gulf Coast Kidney Associates, Pl |
|---|---|
| Speciality | Internal Medicine |
| Location | 1921 Waldemere St, Sarasota, Florida |
| Authorized Official Name and Position | Andrew L. Lazin (STAFF PHYSICIAN) |
| Authorized Official Contact | 9419178722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Kidney Associates, Pl 1921 Waldemere St Suite 306 Sarasota FL 34239-2943 Ph: (941) 917-8722 | Gulf Coast Kidney Associates, Pl 1921 Waldemere St Suite 306 Sarasota FL 34239-2943 Ph: (941) 917-8722 |
| NPI Number | 1962467373 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 05/24/2010 |
| Medicare PECOS PAC ID | 0648243162 |
|---|---|
| Medicare Enrollment ID | O20040813000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962467373 | NPI | - | NPPES |
| 254520001 | Medicaid | FL | |
| 254542000 | Medicaid | FL | |
| 38341 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Primary |
| Provider Name | Andrew Lazin |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1881686079 PECOS PAC ID: 8729998927 Enrollment ID: I20100222000608 |
| Provider Name | Dennis R Imperio |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1417949611 PECOS PAC ID: 6608849120 Enrollment ID: I20100222000639 |
| Provider Name | Janis S Lawrence-jackson |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1063640126 PECOS PAC ID: 0648322842 Enrollment ID: I20130911000662 |
| Provider Name | Samantha Kalakurthy |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1124227319 PECOS PAC ID: 7113081738 Enrollment ID: I20171227000319 |
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