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General NPI Number Information
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NPI Number | 1295753176
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS NEPHROLOGY, S.C
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1340 CHARLES ST STE 400
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City | ROCKFORD
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State | IL
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Zip | 61104-2200
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Country | US
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Telephone | 815-398-9590
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 CHARLES ST STE 400
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City | ROCKFORD
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State | IL
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Zip | 61104-2200
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Country | US
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Telephone | 815-398-9590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DAVID L WRIGHT
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Credential | MD
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Telephone | 815-398-9590
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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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