Healthcare Provider Details

I. General information

NPI: 1386837987
Provider Name (Legal Business Name): GRUNDY RADIOLOGISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HIGH ST
MORRIS IL
60450-1463
US

IV. Provider business mailing address

1200 HARGER RD STE 408
OAK BROOK IL
60523-1818
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-6504
  • Fax:
Mailing address:
  • Phone: 630-581-6504
  • Fax: 815-941-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036092647
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL T JACHEC
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-941-1790