Provider Demographics
NPI:1548315849
Name:MIDWEST NEPHROLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:MIDWEST NEPHROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-749-4617
Mailing Address - Street 1:6827 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3287
Mailing Address - Country:US
Mailing Address - Phone:708-749-4617
Mailing Address - Fax:
Practice Address - Street 1:6827 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3287
Practice Address - Country:US
Practice Address - Phone:708-749-4617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL60706Medicare UPIN
IL212107Medicare ID - Type Unspecified
ILC42416Medicare UPIN