Healthcare Provider Details

I. General information

NPI: 1114057288
Provider Name (Legal Business Name): BJ DIAGNOSTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W 69TH ST
CHICAGO IL
60636-3316
US

IV. Provider business mailing address

PO BOX 9293
AURORA IL
60598-9293
US

V. Phone/Fax

Practice location:
  • Phone: 773-471-0017
  • Fax:
Mailing address:
  • Phone: 630-585-8372
  • Fax: 630-585-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMAD A JAMAL
Title or Position: PRESIDENT
Credential:
Phone: 630-585-8372