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General NPI Number Information
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NPI Number | 1225848435
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Entity Type | Organization
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Legal Business Name | KIDNEY HEALTH CENTER LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1860 W WINCHESTER RD STE 107
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5312
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Country | US
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Telephone | 847-247-1010
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Fax | 847-247-1011
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Provider Business Mailing Address
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Address Line | 1860 W WINCHESTER RD STE 107
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5312
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Country | US
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Telephone | 847-247-1010
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Fax | 847-247-1011
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Authorized Official
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Title or Position | OWNER
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Name | OMAR DALLOUL
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Credential | MD
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Telephone | 847-247-1010
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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 |
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License Number State |
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