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General NPI Number Information
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NPI Number | 1114290475
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Entity Type | Organization
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Legal Business Name | JOLIET DIALYSIS HOLDINGS, LLC
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 368 S. WEBER ROAD
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City | ROMEOVILLE
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State | IL
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Zip | 60446
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Country | US
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Telephone | 815-254-0283
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Fax | 815-254-1397
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Provider Business Mailing Address
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Address Line | 368 S. WEBER ROAD
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City | ROMEOVILLE
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State | IL
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Zip | 60446
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Country | US
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Telephone | 815-254-0283
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Fax | 815-254-1397
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Authorized Official
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Title or Position | CEO
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Name | ZDZISLAWA TERESA MAJKA-KRAVETS
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Credential | MD
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Telephone | 815-245-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 042.005614
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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