MEDICARE: MIDWEST RADIOLOGY ASSOCIATES SC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1114955622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST RADIOLOGY ASSOCIATES SC

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	6130 N SHERIDAN RD
Second Line	:	VENCOR HOSPITAL - LAKESHORE
City	:	CHICAGO
State	:	IL
Zip	:	60660-2830
Country	:	US
Telephone Number	:	773-736-7000
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	JOSEPH J. PORADA
Credential	:	M.D.
Telephone Number	:	773-736-7000

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/26/2007

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