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Organization
KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD
Active
Organization
KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD S SHAFI MC (OWNER)
(618) 542-3048
Entity
Organization
Contact information
Practice address
900 N WASHINGTON ST, DU QUOIN, IL 62832-1230
(618) 542-3048
(618) 542-3097
Mailing address
PO BOX 181, DU QUOIN, IL 62832-0181
(618) 542-3048
(618) 542-3097
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036102569
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102569
—
IL
Enumeration date
03/05/2007
Last updated
08/12/2008
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