Healthcare Provider Details

I. General information

NPI: 1760885750
Provider Name (Legal Business Name): ONSITE DIAGNOSTICS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 LYONS ST
MORTON GROVE IL
60053-1546
US

IV. Provider business mailing address

5630 LYONS ST
MORTON GROVE IL
60053-1546
US

V. Phone/Fax

Practice location:
  • Phone: 847-810-9095
  • Fax:
Mailing address:
  • Phone: 847-810-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ISSAM MAATOUK
Title or Position: OWNER
Credential: MD
Phone: 847-810-9095