MEDICARE: MEDIQUEST DIAGNOSTIC CENTER S.C

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	2471C3402X	Radiography Radiologic Technologist	9258142	IL
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular	N / A	IL

General Provider Information

NPI Number	:	1568419778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIQUEST DIAGNOSTIC CENTER S.C

Provider Business Mailing Address
First Line	:	3420 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3418
Country	:	US
Telephone Number	:	773-604-4305
Fax Number	:	847-296-8860

Provider Business Practice Location Address
First Line	:	3420 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3418
Country	:	US
Telephone Number	:	773-604-4305
Fax Number	:	847-296-8860

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SABIHA N AHMED
Credential	:	B.S
Telephone Number	:	630-894-6105

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/15/2013

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