MEDICARE: FOX VALLEY MEDICAL DIAGNOSTIC SERVICES INC.

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
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1114247632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY MEDICAL DIAGNOSTIC SERVICES INC.

Provider Business Mailing Address
First Line	:	3535 E NEW YORK STREET
Second Line	:	SUITE 118
City	:	AURORA
State	:	IL
Zip	:	60504-4466
Country	:	US
Telephone Number	:	630-820-8586
Fax Number	:	630-820-8589

Provider Business Practice Location Address
First Line	:	3535 E NEW YORK STREET
Second Line	:	SUITE 118
City	:	AURORA
State	:	IL
Zip	:	60504-4466
Country	:	US
Telephone Number	:	630-820-8586
Fax Number	:	630-820-8589

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZAINULABUDDIN SYED
Credential	:	M.D.
Telephone Number	:	630-820-8586

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	09/10/2015

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