Provider Demographics
NPI:1801041645
Name:NORTH SUBURBAN NEPHROLOGY LLC
Entity Type:Organization
Organization Name:NORTH SUBURBAN NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:N
Authorized Official - Last Name:GHANTOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-446-3200
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:1425 N HUNT CLUB RD STE 301
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2639
Practice Address - Country:US
Practice Address - Phone:847-855-9252
Practice Address - Fax:847-855-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01553437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty