MEDICARE: FUTURE DIAGNOSTICS, LTD.

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621502	OTHER	IL	BLUE CROSS BLUE SHIELD PR

General Provider Information

NPI Number	:	1194872457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUTURE DIAGNOSTICS, LTD.

Provider Business Mailing Address
First Line	:	2804 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-274-7870
Fax Number	:	773-274-7860

Provider Business Practice Location Address
First Line	:	2804 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-274-7870
Fax Number	:	773-274-7860

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GRIGORIY CHECHELNITSKIY
Credential	:
Telephone Number	:	773-274-7870

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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Directions to “FUTURE DIAGNOSTICS, LTD. ” Practice Location

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