Healthcare Provider Details

I. General information

NPI: 1689727471
Provider Name (Legal Business Name): NORTHSHORE IMAGING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 N WESTERN AVE
CHICAGO IL
60645-1735
US

IV. Provider business mailing address

7455 N WESTERN AVE
CHICAGO IL
60645-1735
US

V. Phone/Fax

Practice location:
  • Phone: 773-262-4432
  • Fax: 773-262-4712
Mailing address:
  • Phone: 773-262-4432
  • Fax: 773-262-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MASOOD SIDDIQUI
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-262-4432