Healthcare Provider Details

I. General information

NPI: 1972703080
Provider Name (Legal Business Name): VALLEY LO IMAGING CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 TANGLEWOOD DR UNIT F
GLENVIEW IL
60025-1636
US

IV. Provider business mailing address

PO BOX 2068
GLENVIEW IL
60025-6068
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-0909
  • Fax:
Mailing address:
  • Phone: 847-845-0909
  • Fax: 847-729-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: BORIS KORNEYEV
Title or Position: BOARD OF DIRECTORS
Credential:
Phone: 847-845-0909