Organization
VITALITY HOME DIALYSIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHSAN USMAN MD (OWNER)
(314) 560-9648
Entity
Organization
Contact information
Practice address
100 FAITH DR STE A, HIGHLAND, IL 62249-2638
(314) 560-9648
Mailing address
100 FAITH DR STE A, HIGHLAND, IL 62249-2638
(314) 560-9648
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2024
Last updated
01/18/2024
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