Healthcare Provider Details

I. General information

NPI: 1316057334
Provider Name (Legal Business Name): WELLINGTON RADIOLOGY GROUP, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 WEST WELLINGTON AVE
CHICAGO IL
60657
US

IV. Provider business mailing address

39006 TREASURY CENTER
CHICAGO IL
60694-9000
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7820
  • Fax: 773-296-7821
Mailing address:
  • Phone: 708-460-7444
  • Fax: 708-460-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SPR NAOIMPALLI
Title or Position: DIRECTOR
Credential: MD
Phone: 773-296-7820