Basic Information
| Provider Information | |||||||||
| NPI: | 1780637744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUPAGE NEPHROLOGY ASSOCIATES SC | ||||||||
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| OtherOrganizationName: | DUPAGE NEPHRO MED ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 183 N ADDISON AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308322183 | ||||||||
| FaxNumber: | 6308322184 | ||||||||
| Practice Location | |||||||||
| Address1: | 183 N ADDISON AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308322183 | ||||||||
| FaxNumber: | 6308322184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | MUNEER | ||||||||
| AuthorizedOfficialFirstName: | RUKHSANA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6308322183 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 2215498 | 01 | IL | BCBS OF IL PROVIDER ID | OTHER |