Provider Demographics
NPI:1366844904
Name:CONCERTO HOME DIALYSIS LLC
Entity Type:Organization
Organization Name:CONCERTO HOME DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-233-1202
Mailing Address - Street 1:4600 W TOUHY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1630
Mailing Address - Country:US
Mailing Address - Phone:847-233-1202
Mailing Address - Fax:847-233-1302
Practice Address - Street 1:4600 W TOUHY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1630
Practice Address - Country:US
Practice Address - Phone:847-233-1202
Practice Address - Fax:847-233-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment