Healthcare Provider Details

I. General information

NPI: 1083982052
Provider Name (Legal Business Name): DAISY OMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD SUITE 1337
CHICAGO IL
60604-3606
US

IV. Provider business mailing address

53 W JACKSON BLVD SUITE 1337
CHICAGO IL
60604-3606
US

V. Phone/Fax

Practice location:
  • Phone: 312-344-1401
  • Fax: 312-344-1402
Mailing address:
  • Phone: 312-344-1401
  • Fax: 312-344-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTY KITZMILLER
Title or Position: PRESIDENT
Credential:
Phone: 312-344-1401