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General NPI Number Information
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NPI Number | 1700245982
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Entity Type | Organization
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Legal Business Name | MIDWEST NEPHROLOGY & INTERNAL MEDICINE ASSOCIATES, CORP.
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1985 N MANNHEIM RD
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City | MELROSE PARK
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State | IL
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Zip | 60160-1012
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Country | US
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Telephone | 219-299-3388
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Fax | 708-223-5739
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Provider Business Mailing Address
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Address Line | 1985 N MANNHEIM RD
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City | MELROSE PARK
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State | IL
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Zip | 60160-1012
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Country | US
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Telephone | 219-299-3388
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJANI KOSURI
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Credential | M.D.
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Telephone | 708-689-8539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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