Organization
DIRECT DIALYSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHARLES BRAUN (CONTROLLER)
(847) 583-0100
Entity
Organization
Contact information
Practice address
14255 CICERO AVE, CRESTWOOD, IL 60445-2154
(708) 824-9200
Mailing address
14255 CICERO AVE, CRESTWOOD, IL 60445-2154
(708) 824-9200
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
IL
Other
Enumeration date
08/21/2006
Last updated
08/22/2020
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