Provider Demographics
NPI:1043555360
Name:KIDNEY HEALTH CARE PC
Entity Type:Organization
Organization Name:KIDNEY HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:USMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-642-6705
Mailing Address - Street 1:19 OLT AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6214
Mailing Address - Country:US
Mailing Address - Phone:309-642-6705
Mailing Address - Fax:309-347-2623
Practice Address - Street 1:19 OLT AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6214
Practice Address - Country:US
Practice Address - Phone:309-642-6705
Practice Address - Fax:309-347-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121212207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty