Healthcare Provider Details

I. General information

NPI: 1033513262
Provider Name (Legal Business Name): DHK RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E ERIE ST APT 2203
CHICAGO IL
60611-2798
US

IV. Provider business mailing address

55 E ERIE ST APT 2203
CHICAGO IL
60611-2798
US

V. Phone/Fax

Practice location:
  • Phone: 847-691-7673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1062709
License Number StateIL

VIII. Authorized Official

Name: JAY KORACH
Title or Position: OWNER
Credential:
Phone: 847-691-7673