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General NPI Number Information
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NPI Number | 1962518449
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Entity Type | Organization
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Legal Business Name | ELGIN NEPHROLOGY ASSOCIATES., S.C.
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 296 W SPRING ST
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1534
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Country | US
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Telephone | 847-697-2692
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Fax |
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Provider Business Mailing Address
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Address Line | 296 W SPRING ST
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1534
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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 | OFFICE MANAGER
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Name | MARY M PETKOVIC
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Credential |
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Telephone | 847-697-2692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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