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General NPI Number Information
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NPI Number | 1356599732
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Entity Type | Organization
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Legal Business Name | CENTRAL DUPAGE IMAGING CENTER LLC
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 2001 N GARY AVENUE SUITE # 100
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City | WHEATON
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State | IL
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Zip | 60187
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Country | US
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Telephone | 630-614-4260
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Fax | 630-614-4275
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Provider Business Mailing Address
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Address Line | 2001 N GARY AVENUE SUITE # 100
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City | WHEATON
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State | IL
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Zip | 60187
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Country | US
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Telephone | 630-614-4260
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Fax | 630-614-4275
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | HEIDI A COUPLAND
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Credential |
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Telephone | 480-736-2991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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