Healthcare Provider Details

I. General information

NPI: 1073353157
Provider Name (Legal Business Name): PSC CARDIORAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BUTTERFIELD RD STE 108
DOWNERS GROVE IL
60515-5620
US

IV. Provider business mailing address

1323 BUTTERFIELD RD STE 108
DOWNERS GROVE IL
60515-5620
US

V. Phone/Fax

Practice location:
  • Phone: 331-230-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED SAKARIA
Title or Position: CEO
Credential:
Phone: 331-230-2500