Unknown Individual – Nephrology Physician, NPI 1316926967

Nephrology Physician

Unknown Individual is a healthcare provider. based in Maywood, Illinois. specializing in Nephrology Physician. They hold a License No. 36059226 (IL). The NPI Number for Unknown Individual is 1316926967

Main info

Organization

Inactive

59 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1316926967

Phone

(708) 216-9000

Address

2160 S FIRST AVE

Deactivation Date

16 May 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7082169000

Graduation Year

1967 (59 years ago)

PAC ID

2163584996

Group Practice PAC ID

3779488903

Professional Enrollment ID

I20090102000325

Contacts

Secure Messaging

abidani14087@direct.luhs.org

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

2160 S FIRST AVE
101-1740, LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD, IL 60153
Phone: (708) 216-9000
Fax: (708) 216-9033
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60153)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3779488903View full group profile

Name	Specialty	State
GEETA BOLLAM (MD)	-	IL
SUSANNE TIDOW-KEBRITCHI (MD)	-	IL
MICHAEL JOEL SCHNECK (MD)	N E U R O L O G Y	IL
DR. DEEPTI SHIVAKUMAR (MD)	Family Practice	IL
DR. DENNIS ALAN PEACOCK (MD)	Internal Medicine, Pediatric Medicine	IL
ASHRAF ABDELJABER (M.D)	Hospitalist, Family Practice	TX
DR. WALTER J WOJCIK (M.D,,PH.D.)	-	IL
MICHAEL CLARK (MD)	-	IL
WICKII VIGNESWARAN (MD)	-	IL
MS. NANCY L PORTER (APN)	-	IL