Organization
NEPHRON DIALYSIS CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY J KOCALIS M.D. (PRESIDENT/CEO)
(773) 293-2100
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE, SUITE 510, CHICAGO, IL 60625-3645
(773) 293-2100
(773) 293-2101
Mailing address
5140 N CALIFORNIA AVE, SUITE 510, CHICAGO, IL 60625-3645
(773) 293-2100
(773) 293-2101
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135
BLUECROSS BLUESHIELD
IL
Enumeration date
07/21/2006
Last updated
09/09/2015
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