Healthcare Provider Details

I. General information

NPI: 1568652428
Provider Name (Legal Business Name): POLSONO MOBILE ULTRASOUND, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/21/2022
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N STATE ST APT 17H
CHICAGO IL
60610-5492
US

IV. Provider business mailing address

1030 N STATE ST APT 17H
CHICAGO IL
60610-5492
US

V. Phone/Fax

Practice location:
  • Phone: 847-428-9629
  • Fax: 630-423-9549
Mailing address:
  • Phone: 847-428-9629
  • Fax: 630-423-9549

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: JOYCE MARIE BOWEN
Title or Position: PRESIDENT
Credential:
Phone: 847-428-9629