Healthcare Provider Details

I. General information

NPI: 1245490903
Provider Name (Legal Business Name): CDI GENEVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 S RANDALL RD SUITE C1
GENEVA IL
60134-4682
US

IV. Provider business mailing address

5775 WAYZATA BLVD SUITE 400
ST LOUIS PARK MN
55416-1222
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-9325
  • Fax: 630-208-9326
Mailing address:
  • Phone: 952-525-6338
  • Fax: 952-513-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMONA AHERN
Title or Position: SPECIAL ASSISTANT SECRETARY
Credential:
Phone: 952-738-4441