MEDICARE: WESTERN SPRINGS DIAGNOSTIC OSTEOPOROSIS CENTER, LLC

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	261QR0200X	Radiology Clinic/Center	9255759	IL

General Provider Information

NPI Number	:	1184703209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN SPRINGS DIAGNOSTIC OSTEOPOROSIS CENTER, LLC

Provider Business Mailing Address
First Line	:	5600 WOLF RD STE 160
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-783-1198
Fax Number	:	708-246-7286

Provider Business Practice Location Address
First Line	:	5600 WOLF RD STE 160
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-783-1198
Fax Number	:	708-246-7286

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY A FRUMKIN
Credential	:	M.D.
Telephone Number	:	708-246-7222

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/25/2008

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