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NPI Code Detail

MEDICARE: ILLINOIS VALLEY RADIOLOGY

MEDICARE: ILLINOIS VALLEY RADIOLOGY
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 Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105023282OTHERILBC BS

General Provider Information

NPI Number : 1124027826
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILLINOIS VALLEY RADIOLOGY
Provider Business Mailing Address
First Line : 4234 N BRANDYWINE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-5566
Country : US
Telephone Number : 866-286-5887
Fax Number :
Provider Business Practice Location Address
First Line : 111 SPRING ST
Second Line :
City : STREATOR
State : IL
Zip : 61364-3332
Country : US
Telephone Number : 815-673-2311
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARK HILBORN
Credential : MD
Telephone Number : 815-673-2311
Provider Enumeration Date : 07/15/2005
Last Update Date : 04/20/2008

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Directions to “ILLINOIS VALLEY RADIOLOGY ” Practice Location

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