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General NPI Number Information
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NPI Number | 1497971881
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Entity Type | Organization
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Legal Business Name | UNIVERSAL RADIOLOGY LTD
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 326 WEST 64TH STREET
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City | CHICAGO
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State | IL
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Zip | 60621
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Country | US
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Telephone | 773-962-3900
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Fax | 773-602-3849
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Provider Business Mailing Address
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Address Line | 2158 45TH ST. #519
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City | HIGHLAND
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State | IN
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Zip | 46322-3742
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Country | US
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Telephone | 773-962-3900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH CARRE
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Credential | MD
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Telephone | 773-962-3900
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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 | 036065253
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License Number State | IL
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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 | 036039380
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License Number State | IL
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