Organization
DIALYSIS AT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHIDA M KHAN (OWNER)
(847) 401-6079
Entity
Organization
Contact information
Practice address
11638 S WESTERN AVE, CHICAGO, IL 60643-4730
(224) 735-3638
Mailing address
11638 S WESTERN AVE, CHICAGO, IL 60643-4730
(224) 735-3638
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
IL
Other
Enumeration date
02/16/2015
Last updated
03/27/2015
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