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General NPI Number Information
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NPI Number | 1104378942
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Entity Type | Organization
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Legal Business Name | RADIOLOGY SUBSPECIALISTS OF NORTHERN ILLINOIS, LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 825 W STATE ST SUITE 103E
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City | GENEVA
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State | IL
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Zip | 60134-2080
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Country | US
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Telephone | 630-208-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 825 W STATE ST SUITE 103E
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City | GENEVA
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State | IL
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Zip | 60134-2080
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Country | US
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Telephone | 630-208-4412
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DIANE SARKA
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Credential |
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Telephone | 630-928-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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