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NPI Code Detail

MEDICARE: DAC IMAGING S C

MEDICARE: DAC IMAGING S C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician036072329IL

General Provider Information

NPI Number : 1083052757
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAC IMAGING S C
Provider Business Mailing Address
First Line : 4800 S GREENWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60615-1914
Country : US
Telephone Number : 312-315-8046
Fax Number : 312-284-4800
Provider Business Practice Location Address
First Line : 4800 S GREENWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60615-1914
Country : US
Telephone Number : 312-315-8046
Fax Number : 312-284-4800
Authorized Official
Title or Position : OWNER
Name : DR. DALE A CHARLETTA
Credential : MD
Telephone Number : 312-315-8046
Provider Enumeration Date : 06/04/2013
Last Update Date : 06/04/2013

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Directions to “DAC IMAGING S C ” Practice Location

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