Provider Demographics
NPI:1538190129
Name:KIDNEY DISEASE AND MEDICINE SPECIALTY CONSULTANTS LLC
Entity type:Organization
Organization Name:KIDNEY DISEASE AND MEDICINE SPECIALTY CONSULTANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-529-2955
Mailing Address - Street 1:1350 CEDAR COURT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-529-2955
Mailing Address - Fax:618-457-7823
Practice Address - Street 1:1350 CEDAR COURT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-529-2955
Practice Address - Fax:618-457-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092577Medicaid
IL209286Medicare PIN
IL209287Medicare PIN
ILF96874Medicare UPIN