Healthcare Provider Details

I. General information

NPI: 1568524841
Provider Name (Legal Business Name): RADIOLOGY IMAGING CONSULTANTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

75 REMITTANCE DR DEPT 1186
CHICAGO IL
60675-1186
US

V. Phone/Fax

Practice location:
  • Phone: 708-331-7800
  • Fax: 708-339-0695
Mailing address:
  • Phone:
  • Fax: 708-339-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026