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General NPI Number Information
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NPI Number | 1558618512
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Entity Type | Organization
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Legal Business Name | PRECISION DIAGNOSTICS
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 18623 81ST AVE
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City | TINLEY PARK
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State | IL
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Zip | 60487-6279
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Country | US
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Telephone | 708-712-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 18623 81ST AVE
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City | TINLEY PARK
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State | IL
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Zip | 60487-6279
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Country | US
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Telephone | 708-712-7615
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MALCOLM HERZOG
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Credential |
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Telephone | 708-380-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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