Organization Name: | ILLIANA DIAGNOSTICS, LLC |
NPI Number: | 1205092350 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEE B PATEL (PRESIDENT) |
Mailing Address: | 3759 W 95th St Suite 2 Evergreen Pk |
State: | IL US |
Postal Code: | 608052000 |
Phone Number: | 7089524900 |
Fax Number: | 7089524949 |
NPI Enumeration Date: | 07/29/2008 |
NPI Last Update Date: | 07/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0208X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology, Mobile |
Taxonomy Definition: |