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Organization
MIDWEST NEPHROLOGY GROUP, LLC
Active
Organization
MIDWEST NEPHROLOGY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATESWARARAO ALLA M.D. (MEDICAL DIRECTORE)
(815) 284-0555
Entity
Organization
Contact information
Practice address
101 WEST 2ND STREET, DIXON, IL 61021-3053
(815) 284-0555
(815) 284-0580
Mailing address
101 WEST 2ND STREET, DIXON, IL 61021-3053
(815) 284-0555
(815) 284-0580
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056049
—
IL
05
—
036103114
—
IL
05
—
036114547
—
IL
01
—
05232009
BCBS
IL
Enumeration date
12/06/2006
Last updated
03/04/2009
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