Healthcare Provider Details

I. General information

NPI: 1588065189
Provider Name (Legal Business Name): RENAL CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 N NELTNOR BLVD SUITE C
WEST CHICAGO IL
60185-5900
US

IV. Provider business mailing address

1865 N NELTNOR BLVD SUITE C
WEST CHICAGO IL
60185-5900
US

V. Phone/Fax

Practice location:
  • Phone: 630-876-9000
  • Fax: 630-242-8450
Mailing address:
  • Phone: 630-876-9000
  • Fax: 630-242-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036135417
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036135417
License Number StateIL

VIII. Authorized Official

Name: MOQUEET SYED
Title or Position: MANAGER
Credential:
Phone: 630-440-7786