Healthcare Provider Details

I. General information

NPI: 1982775631
Provider Name (Legal Business Name): CENTER FOR RENAL REPLACEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N LINCOLN AVE SUITE 205
LINCOLNWOOD IL
60712-1709
US

IV. Provider business mailing address

4354 W PRATT AVE
LINCOLNWOOD IL
60712-3544
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-5555
  • Fax: 847-675-7019
Mailing address:
  • Phone: 847-674-0071
  • Fax: 847-674-3878

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: DR. JAMES K YEUNG
Title or Position: MEDICAL DIRECTOR AND ADMINISTRATOR
Credential: M.D.
Phone: 847-675-5555