Provider Demographics
NPI:1528156676
Name:ILLIANA NEPHROLOGY ASSOCIATES LTD
Entity type:Organization
Organization Name:ILLIANA NEPHROLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOGHNOGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-5160
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46325-0583
Mailing Address - Country:US
Mailing Address - Phone:217-836-5160
Mailing Address - Fax:
Practice Address - Street 1:8230 CALUMET
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1753
Practice Address - Country:US
Practice Address - Phone:217-836-5160
Practice Address - Fax:217-836-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211453Medicare PIN
IN220430Medicare PIN
IN220430Medicare ID - Type Unspecified