Provider Demographics
NPI:1699772525
Name:DIAMOND DIALYSIS OF OAK LAWN
Entity type:Organization
Organization Name:DIAMOND DIALYSIS OF OAK LAWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAFUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-423-0300
Mailing Address - Street 1:9115 S CICERO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1895
Mailing Address - Country:US
Mailing Address - Phone:708-423-0300
Mailing Address - Fax:708-423-7730
Practice Address - Street 1:9115 S CICERO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1895
Practice Address - Country:US
Practice Address - Phone:708-423-0300
Practice Address - Fax:708-423-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL142661Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER