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General NPI Number Information
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NPI Number | 1003861659
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Entity Type | Organization
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Legal Business Name | CONSULTANT RADIOLOGISTS OF EVANSTON, S.C.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 355 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60202-3328
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Country | US
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Telephone | 847-316-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 355 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60202-3328
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Country | US
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Telephone | 847-316-6101
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH D CALANDRA
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Credential | M.D.
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Telephone | 847-316-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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