Healthcare Provider Details

I. General information

NPI: 1174894539
Provider Name (Legal Business Name): PREMIER DIAGNOSTIC IMAGING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 E OAKTON ST #113
DES PLAINES IL
60018-2168
US

IV. Provider business mailing address

1784 E OAKTON ST #113
DES PLAINES IL
60018-2168
US

V. Phone/Fax

Practice location:
  • Phone: 847-376-8959
  • Fax:
Mailing address:
  • Phone: 847-376-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAWEED NAWAZ
Title or Position: PRESIDENT
Credential:
Phone: 872-985-1023