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NPI Code Detail

MEDICARE: NORTHWEST KIDNEY KARE PC

MEDICARE: NORTHWEST KIDNEY KARE PC
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
1207RN0300XNephrology Physician

General Provider Information

NPI Number : 1386681195
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST KIDNEY KARE PC
Provider Business Mailing Address
First Line : 121 S WILKE RD
Second Line : SUITE 111
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-1533
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 121 S WILKE RD
Second Line : SUITE 111
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-1533
Country : US
Telephone Number : 847-506-0400
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : VINCENT DISILVESTRO
Credential :
Telephone Number : 847-506-0400
Provider Enumeration Date : 06/01/2006
Last Update Date : 07/26/2013

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Directions to “NORTHWEST KIDNEY KARE PC ” Practice Location

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