MEDICARE: FRESENIUS MEDICAL CARE OF ILLINOIS, 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1770541583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE OF ILLINOIS, LLC

Provider Business Mailing Address
First Line	:	4008 N BROADWAY ST
Second Line	:	STE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60613-2111
Country	:	US
Telephone Number	:	773-248-3105
Fax Number	:	773-248-4691

Provider Business Practice Location Address
First Line	:	4008 N BROADWAY ST
Second Line	:	STE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60613-2111
Country	:	US
Telephone Number	:	773-248-3105
Fax Number	:	773-248-4691

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/29/2010

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