Healthcare Provider Details

I. General information

NPI: 1366475121
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

PO BOX 68
NORTHBROOK IL
60065-0068
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5138
  • Fax: 773-792-5124
Mailing address:
  • Phone: 847-412-9213
  • Fax: 847-412-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GREGORY MOSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-792-5138