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NPI Code Detail

MEDICARE: NORTHERN ILLINOIS SCANNING

MEDICARE: NORTHERN ILLINOIS SCANNING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1063480697
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN ILLINOIS SCANNING
Provider Business Mailing Address
First Line : 1401 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number : 815-489-4760
Fax Number :
Authorized Official
Title or Position : MD
Name : EDWARD STEFFEN
Credential : MD
Telephone Number : 815-489-4760
Provider Enumeration Date : 03/09/2006
Last Update Date : 08/22/2020

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Directions to “NORTHERN ILLINOIS SCANNING ” Practice Location

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