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General NPI Number Information
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NPI Number | 1144283300
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS CONSULTANTS FOR KIDNEY DISEASE, S.C.
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 416 N 12TH ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4314
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Country | US
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Telephone | 618-244-4850
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Fax | 618-244-7985
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Provider Business Mailing Address
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Address Line | PO BOX 1704
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City | MOUNT VERNON
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State | IL
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Zip | 62864-0034
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Country | US
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Telephone | 618-244-4850
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Fax | 618-244-7985
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. STEVEN J. ZELMAN
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Credential | M.D.
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Telephone | 618-244-4850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 060-007470
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License Number State | IL
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