MEDICARE: NEPHROLOGY CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1346019676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	825 S WAUKEGAN RD STE A8
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 W HIGGINS RD STE 4100
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9123
Country	:	US
Telephone Number	:	847-863-0546
Fax Number	:

Authorized Official
Title or Position	:	BILLING AND CREDENTIALING
Name	:	JULIE BOUCKENOOGHE
Credential	:
Telephone Number	:	727-207-7070

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	03/06/2026

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