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General NPI Number Information
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NPI Number | 1386730810
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Entity Type | Organization
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Legal Business Name | ELK GROVE RADIOLOGY S.C.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007
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Country | US
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Telephone | 847-437-5500
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Fax | 847-952-7912
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Provider Business Mailing Address
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Address Line | 800 BIESTERFIELD RD
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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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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