Organization
KIDNEY SPECIALISTS OF ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUSTAFA MOHAMMED ALI M.D. (OWNER)
(847) 942-6848
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE, SUITE 700, CHICAGO, IL 60625-3645
(773) 784-2101
(773) 784-0771
Mailing address
5140 N CALIFORNIA AVE, SUITE 700, CHICAGO, IL 60625-3645
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036.125203
IL
Other
Enumeration date
09/23/2013
Last updated
02/03/2014
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