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General NPI Number Information
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NPI Number | 1184694259
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN NEPHROLOGY, S.C.
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 210 S DESPLAINES ST
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City | CHICAGO
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State | IL
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Zip | 60661-5500
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Country | US
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Telephone | 312-654-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 4026 PAYSPHERE CIR
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City | CHICAGO
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State | IL
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Zip | 60674-0400
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Country | US
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Telephone | 312-654-2720
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Fax | 312-654-9930
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMITABHA MITRA
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Credential |
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Telephone | 312-654-2720
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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 | 036133704
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License Number State | IL
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