MEDICARE: PREMIER DIAGNOSTIC IMAGING SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular
2	2471S1302X	Sonography Radiologic Technologist
3	2471V0105X	Vascular Sonography Radiologic Technologist
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1174894539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER DIAGNOSTIC IMAGING SERVICES INC

Provider Business Mailing Address
First Line	:	1784 E OAKTON ST
Second Line	:	#113
City	:	DES PLAINES
State	:	IL
Zip	:	60018-2168
Country	:	US
Telephone Number	:	847-376-8959
Fax Number	:

Provider Business Practice Location Address
First Line	:	1784 E OAKTON ST
Second Line	:	#113
City	:	DES PLAINES
State	:	IL
Zip	:	60018-2168
Country	:	US
Telephone Number	:	847-376-8959
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAWEED NAWAZ
Credential	:
Telephone Number	:	872-985-1023

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	11/28/2016

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