Healthcare Provider Details

I. General information

NPI: 1124069182
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

IV. Provider business mailing address

120 W 22ND ST
OAK BROOK IL
60523-1557
US

V. Phone/Fax

Practice location:
  • Phone: 630-575-5000
  • Fax:
Mailing address:
  • Phone: 630-573-5000
  • Fax: 630-368-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MANISH TANNA
Title or Position: PRESIDENT
Credential: MD
Phone: 630-573-5000