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Organization
NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Active
Organization
NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN O'DEA (CFO/COO)
(708) 386-1000
Entity
Organization
Contact information
Practice address
650 DAKOTA ST, SUITE C, CRYSTAL LAKE, IL 60012-3744
(815) 301-1001
(815) 301-1002
Mailing address
PO BOX 94644, CLEVELAND, OH 44101-4644
(630) 573-5000
(630) 368-0280
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036110997
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548210677
PROVIDER NPI NUMBER
IL
Enumeration date
10/29/2008
Last updated
11/02/2021
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