Healthcare Provider Details

I. General information

NPI: 1184703209
Provider Name (Legal Business Name): WESTERN SPRINGS DIAGNOSTIC OSTEOPOROSIS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 WOLF RD STE 160
WESTERN SPRINGS IL
60558-2254
US

IV. Provider business mailing address

5600 WOLF RD STE 160
WESTERN SPRINGS IL
60558-2254
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-1198
  • Fax: 708-246-7286
Mailing address:
  • Phone: 708-783-1198
  • Fax: 708-246-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number9255759
License Number StateIL

VIII. Authorized Official

Name: DR. GARY A FRUMKIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-246-7222