Brevard Nephrology Group PA
NPI #1003029786 in Merritt Island, Florida
Provider Information
- NPI Number
- 1003029786
- Entity Type
- Organization
- Organization Name
- Brevard Nephrology Group PA
- Primary Specialty
- Internal Medicine - Nephrology
- Enumeration Date
- May 8, 2007
- Last Updated
- Nov 14, 2012
Practice Location
- Address
- 245 S COURTENAY PARKWAY
- Address 2
- BLDG B
- City
- Merritt Island
- State
- Florida
- ZIP Code
- 32952
- Phone
- (321) 453-5326
Authorized Official
- Name
- CHARLES K WANICH, MD
- Title
- PHYSICIAN
- Phone
- (321) 453-5326
Specialties & Taxonomy Codes
| Specialty |
|---|
| Internal Medicine - Nephrology — Nephrology |
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