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General NPI Number Information
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NPI Number | 1083891865
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN RADIOLOGY & ULTRASOUND PC
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 3304 GROVE AVE
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City | BERWYN
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State | IL
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Zip | 60402-3448
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Country | US
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Telephone | 708-795-1655
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Fax | 708-795-1664
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Provider Business Mailing Address
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Address Line | 3304 GROVE AVE
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City | BERWYN
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State | IL
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Zip | 60402-3448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT ALAN MARSHALL
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Credential | M.D.
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Telephone | 708-795-1655
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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 |
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