Provider Demographics
NPI:1447359310
Name:RENAL MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:RENAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-3456
Mailing Address - Street 1:2100 WEBSTER ST STE 320
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2377
Mailing Address - Country:US
Mailing Address - Phone:415-923-3456
Mailing Address - Fax:415-923-3121
Practice Address - Street 1:2100 WEBSTER ST STE 320
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2377
Practice Address - Country:US
Practice Address - Phone:415-923-3456
Practice Address - Fax:415-923-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A517650OtherSTATE LICENSE
CA00A517651OtherMEDICARE INDIVIDUAL PTAN
CA00G623554OtherMEDICARE INDIVIDUAL PTAN
CAZZZ19839ZOtherMEDICARE GROUP PTAN
CA00G623550OtherSTATE LICENSE
CA00A517650Medicaid
CA00G623551Medicaid
CA00A997520Medicaid
CA00G203560Medicaid
CA00G203560OtherSTATE LICENSE
CA00G203562OtherMEDICARE INDIVIDUAL PTAN
CA00A521550Medicaid
CAA52155OtherLICENSE
CA00A521551OtherMEDICARE INDIVIDUAL PTAN
CA00A997520OtherMEDICARE INDIVIDUAL PTAN
CA00A517651OtherMEDICARE INDIVIDUAL PTAN
CA00G623550OtherSTATE LICENSE
00A997520Medicare UPIN
CA00A517650Medicaid
CA00A997520Medicaid
CA00G203560Medicaid
CA00A521550Medicaid