Healthcare Provider Details

I. General information

NPI: 1871234815
Provider Name (Legal Business Name): ALL-STAT PORTABLE MI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHIP ST STE 209
SAINT JOSEPH MI
49085-1155
US

IV. Provider business mailing address

8235 CHRISTIANA AVE
SKOKIE IL
60076-2910
US

V. Phone/Fax

Practice location:
  • Phone: 224-337-1203
  • Fax: 224-337-1204
Mailing address:
  • Phone: 224-337-1000
  • Fax: 224-337-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ETAI SOOLIMAN
Title or Position: CEO
Credential:
Phone: 224-337-1000