Provider Demographics
NPI:1457733180
Name:EXCEL KIDNEY CARE LLC
Entity Type:Organization
Organization Name:EXCEL KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MUBEEN
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-853-4429
Mailing Address - Street 1:PO BOX 68698
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60168-0698
Mailing Address - Country:US
Mailing Address - Phone:773-296-3003
Mailing Address - Fax:773-296-3002
Practice Address - Street 1:3002 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:773-296-3003
Practice Address - Fax:773-296-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILHEALTHLINKOtherC81662
IL1457733180Medicaid
IL7642518Other7642518
ILHEALTHLINKOtherC81662