Healthcare Provider Details

I. General information

NPI: 1295077188
Provider Name (Legal Business Name): SPEED IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 S HIGHLAND AVE STE 2D
LOMBARD IL
60148-4527
US

IV. Provider business mailing address

1263 S HIGHLAND AVE STE 2D
LOMBARD IL
60148-4527
US

V. Phone/Fax

Practice location:
  • Phone: 630-814-9911
  • Fax:
Mailing address:
  • Phone: 630-814-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number111990
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number034872
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number111990
License Number StateIL

VIII. Authorized Official

Name: MOHAMMED A ASHFAQ
Title or Position: MR
Credential:
Phone: 630-656-1455