Provider Demographics
NPI:1235461096
Name:KIDNEY CARE CENTER OF NORTHERN ILLINOIS, LLC
Entity Type:Organization
Organization Name:KIDNEY CARE CENTER OF NORTHERN ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORUFU
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-6830
Mailing Address - Street 1:95 N 129TH INFANTRY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5134
Mailing Address - Country:US
Mailing Address - Phone:815-741-6830
Mailing Address - Fax:815-741-6832
Practice Address - Street 1:95 N 129TH INFANTRY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5134
Practice Address - Country:US
Practice Address - Phone:815-741-6830
Practice Address - Fax:815-741-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02551047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213738Medicare UPIN