Organization
PRIMECARE NEPHROLOGY & HYPERTENSION SC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSVALDO ENRIQUE WAGENER M.D. (PRESIDENT)
(708) 609-0197
Entity
Organization
Contact information
Practice address
4810 S KENWOOD AVE, CHICAGO, IL 60615-2016
(708) 609-0197
(708) 338-1790
Mailing address
4810 S KENWOOD AVE, CHICAGO, IL 60615-2016
(708) 609-0197
(708) 338-1780
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036086015
IL
Other
Enumeration date
07/13/2012
Last updated
12/07/2015
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