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General NPI Number Information
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NPI Number | 1104953017
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Entity Type | Organization
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Legal Business Name | SOUMA DIAGNOSTICS, LTD
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR SUITE 1429
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-654-9100
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Fax | 312-654-9202
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Provider Business Mailing Address
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Address Line | PO BOX 11690
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City | CHICAGO
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State | IL
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Zip | 60611-0690
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Country | US
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Telephone | 773-735-2110
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Fax | 773-735-4238
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RUDY E SABBAGH
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Credential | MD,FACOG
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Telephone | 312-654-9100
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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 | IL
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