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General NPI Number Information
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NPI Number | 1427041086
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Entity Type | Organization
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Legal Business Name | LIBERTYVILLE IMAGING ASSOCIATES, INC
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 333 PETERSON RD SUITE 230
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1085
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Country | US
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Telephone | 847-549-8000
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Fax | 847-549-8080
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Provider Business Mailing Address
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Address Line | 333 PETERSON RD SUITE 230
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1085
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Country | US
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Telephone | 847-549-8000
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Fax | 847-549-8080
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SHOUKATH AHMED
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Credential |
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Telephone | 847-549-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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 | IL
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