Healthcare Provider Details

I. General information

NPI: 1659374247
Provider Name (Legal Business Name): DIAMOND DIALYSIS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 S WESTERN AVE STE 105
CHICAGO IL
60620-6232
US

IV. Provider business mailing address

9415 S WESTERN AVE STE 105
CHICAGO IL
60620-6232
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-5200
  • Fax: 773-238-5527
Mailing address:
  • Phone: 773-238-5200
  • Fax: 773-238-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWIN S. NUNEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-238-5200