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General NPI Number Information
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NPI Number | 1114723608
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Entity Type | Organization
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Legal Business Name | ILLINOIS DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY PLLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 7435 W TALCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3707
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Country | US
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Telephone | 773-774-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3948 LEGACY DR STE 106-381
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City | PLANO
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State | TX
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Zip | 75023-8300
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Country | US
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Telephone | 847-637-8711
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOHN KIM
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Credential | MD
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Telephone | 512-653-5622
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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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