Organization
DIAMOND DIALYSIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN S. NUNEZ (ADMINISTRATOR)
(773) 238-5200
Entity
Organization
Contact information
Practice address
9415 S WESTERN AVE, STE 105, CHICAGO, IL 60620-6232
(773) 238-5200
(773) 238-5527
Mailing address
9415 S WESTERN AVE, STE 105, CHICAGO, IL 60620-6232
(773) 238-5200
(773) 238-5527
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
—
1633535
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/27/2005
Last updated
08/22/2020
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