Healthcare Provider Details

I. General information

NPI: 1356599732
Provider Name (Legal Business Name): CENTRAL DUPAGE IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N GARY AVENUE SUITE # 100
WHEATON IL
60187
US

IV. Provider business mailing address

2001 N GARY AVENUE SUITE # 100
WHEATON IL
60187
US

V. Phone/Fax

Practice location:
  • Phone: 630-614-4260
  • Fax: 630-614-4275
Mailing address:
  • Phone: 630-614-4260
  • Fax: 630-614-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HEIDI A COUPLAND
Title or Position: VP OF OPERATIONS
Credential:
Phone: 480-736-2991