MEDICARE: QUALITY DIAGNOSTIC ULTRASOUND, CORP

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
1	261QR0208X	Mobile Radiology Clinic/Center	RDMS 117674

General Provider Information

NPI Number	:	1114117017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY DIAGNOSTIC ULTRASOUND, CORP

Provider Business Mailing Address
First Line	:	4815 W BELLE PLAINE AVE APT 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1841
Country	:	US
Telephone Number	:	773-736-1762
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 W BELLE PLAINE AVE APT 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1841
Country	:	US
Telephone Number	:	773-736-1762
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELZBIETA OSTOJA
Credential	:	RDMS
Telephone Number	:	773-736-1762

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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