Healthcare Provider Details

I. General information

NPI: 1588261978
Provider Name (Legal Business Name): THOREK RADIOLOGY GROUP NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WEST IRVING PARK ROAD
CHICAGO IL
60613
US

IV. Provider business mailing address

850 WEST IRVING PARK ROAD
CHICAGO IL
60613
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-6722
  • Fax: 773-975-6726
Mailing address:
  • Phone: 773-975-6722
  • Fax: 773-975-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD J. BUDD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-975-6705