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General NPI Number Information
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NPI Number | 1568660009
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Entity Type | Organization
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Legal Business Name | MARAYAH DIAGNOSTIC LLC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 08/19/2007
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Provider Practice Location Address
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Address Line | 7247 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone | 708-224-6870
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Fax | 708-636-7906
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Provider Business Mailing Address
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Address Line | 7247 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALI HASAN MATARI
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Credential |
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Telephone | 708-224-6870
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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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