Provider Demographics
NPI:1154675528
Name:NANI ELK GROVE
Entity type:Organization
Organization Name:NANI ELK GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-573-5000
Mailing Address - Street 1:120 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1557
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:847-952-9338
Practice Address - Street 1:120 W 22ND ST
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1557
Practice Address - Country:US
Practice Address - Phone:630-573-5000
Practice Address - Fax:708-386-2839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-06
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty