Healthcare Provider Details

I. General information

NPI: 1467418137
Provider Name (Legal Business Name): EXCELL PORTABLE X-RAY SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 LEHMAN DR
WEST CHICAGO IL
60185-6169
US

IV. Provider business mailing address

2362 LEHMAN DR
WEST CHICAGO IL
60185-6169
US

V. Phone/Fax

Practice location:
  • Phone: 630-762-8863
  • Fax: 630-762-8864
Mailing address:
  • Phone: 630-762-8863
  • Fax: 630-762-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9251659
License Number StateIL

VIII. Authorized Official

Name: MRS. MILYNE C MASING
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 630-762-8863