Healthcare Provider Details

I. General information

NPI: 1902041502
Provider Name (Legal Business Name): MDS DIGITAL PORTABLE X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W LINCOLN AVE SUITE. LL
WEST ALLIS WI
53227-2100
US

IV. Provider business mailing address

3701 JARVIS AVE
SKOKIE IL
60076-4019
US

V. Phone/Fax

Practice location:
  • Phone: 414-321-6666
  • Fax: 414-321-6666
Mailing address:
  • Phone: 847-626-0800
  • Fax: 847-626-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MUNEER HASAN
Title or Position: PRESIDENT
Credential:
Phone: 847-626-0800