Organization
OPTIMUM KIDNEY CARE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED MEDHAT SALEM (PRESIDENT)
(773) 525-4701
Entity
Organization
Contact information
Practice address
331 W SURF ST STE 703, CHICAGO, IL 60657-7227
(773) 525-4701
(773) 326-3539
Mailing address
331 W SURF ST STE 703, CHICAGO, IL 60657-7227
(773) 525-4701
(773) 326-3539
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636011
BCBS PROVIDER ID
IL
01
—
151011
ADVOCATE HLTH PARTNERS ID
IL
01
—
DE4201
RAILROAD MEDICARE
IL
Enumeration date
05/30/2006
Last updated
04/09/2020
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