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General NPI Number Information
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NPI Number | 1023178068
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Entity Type | Organization
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Legal Business Name | MIDLICK'S MEDICAL IMAGING INC.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 6686 DOUBLE EAGLE DR UNIT 103
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City | WOODRIDGE
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State | IL
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Zip | 60517-5428
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Country | US
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Telephone | 630-663-9811
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Fax | 630-663-9018
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Provider Business Mailing Address
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Address Line | 6686 DOUBLE EAGLE DR UNIT 103
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City | WOODRIDGE
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State | IL
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Zip | 60517-5428
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Country | US
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Telephone | 630-663-9811
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Fax | 630-663-9018
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DAVID GEORGE MIDLICK
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Credential |
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Telephone | 630-663-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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