Healthcare Provider Details

I. General information

NPI: 1184783359
Provider Name (Legal Business Name): FOCUS DIAGNOSTIC ULTRASOUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 N PLAINFIELD AVE
CHICAGO IL
60634-1921
US

IV. Provider business mailing address

3848 N PLAINFIELD AVE
CHICAGO IL
60634-1921
US

V. Phone/Fax

Practice location:
  • Phone: 773-704-2910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number117674
License Number StateIL

VIII. Authorized Official

Name: MALGORZATA JABLONSKA
Title or Position: PRESIDENT
Credential:
Phone: 773-704-2910