Organization
VILLA PARK HOME DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WASAY ALI HUMAYUN M.D. (PRESIDENT)
(630) 670-8824
Entity
Organization
Contact information
Practice address
1634 S ARDMORE AVE, VILLA PARK, IL 60181-3742
(630) 670-8824
Mailing address
1634 S ARDMORE AVE, VILLA PARK, IL 60181-3742
(630) 670-8824
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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