Healthcare Provider Details

I. General information

NPI: 1255453528
Provider Name (Legal Business Name): KIDNEY AND HYPERTENSION CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 425
CHICAGO IL
60631-3704
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 425
CHICAGO IL
60631-3704
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-8400
  • Fax: 773-774-8085
Mailing address:
  • Phone: 773-763-8400
  • Fax: 773-774-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number042.617788 036.08684
License Number StateIL

VIII. Authorized Official

Name: LYNN MICHELLE ANDERSON
Title or Position: PHYSICIAN
Credential:
Phone: 773-763-8400