| Organization Name: | BREVARD NEPHROLOGY GROUP PA |
| NPI Number: | 1003029786 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES K WANICH (PHYSICIAN) |
| Mailing Address: | 245 S Courtenay Parkway Bldg B Merritt Island |
| State: | FL US |
| Postal Code: | 32952 |
| Phone Number: | 3214535326 |
| Fax Number: | 3214528507 |
| NPI Enumeration Date: | 05/08/2007 |
| NPI Last Update Date: | 11/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RN0300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Nephrology |
| Taxonomy Definition: | An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |