1306917042 NPI number — UPTOWN NEPHROLOGY ASSOCIATES SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306917042 NPI number — UPTOWN NEPHROLOGY ASSOCIATES SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPTOWN NEPHROLOGY ASSOCIATES SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306917042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4354 W PRATT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-674-0017
Provider Business Mailing Address Fax Number:
847-674-3878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LINCOLNWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60712-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-329-7779
Provider Business Practice Location Address Fax Number:
847-329-0907
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YEUNG
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRECTOR AND CARE PHYSICIAN
Authorized Official Telephone Number:
847-329-7779

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0021605762 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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