Provider Demographics
NPI:1245952449
Name:LAWTON KIDNEY CARE LLC
Entity type:Organization
Organization Name:LAWTON KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-248-3733
Mailing Address - Street 1:5112 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5984
Mailing Address - Country:US
Mailing Address - Phone:580-248-3733
Mailing Address - Fax:
Practice Address - Street 1:5112 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5984
Practice Address - Country:US
Practice Address - Phone:580-248-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty