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General NPI Number Information
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NPI Number | 1629705421
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Entity Type | Organization
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Legal Business Name | EPSILON KIDNEY CARE PC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 2829 GREAT NORTHERN LOOP STE 219
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City | MISSOULA
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State | MT
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Zip | 59808-1752
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Country | US
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Telephone | 630-210-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 3507 FRANKSTOWNE CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-3552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. STELLA AWUA-LARBI
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Credential | MD
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Telephone | 630-210-2550
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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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