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General NPI Number Information
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NPI Number | 1164761649
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Entity Type | Organization
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Legal Business Name | MIDWEST MOBILE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 175 N HARBOR DR SUITE 2111
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City | CHICAGO
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State | IL
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Zip | 60601-7344
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Country | US
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Telephone | 312-502-2286
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Fax |
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Provider Business Mailing Address
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Address Line | 175 N HARBOR DR SUITE 2111
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City | CHICAGO
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State | IL
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Zip | 60601-7344
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Country | US
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Telephone | 312-502-2286
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KAREN M WRAY
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Credential | RDMS, RVT
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Telephone | 312-502-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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