MEDICARE: UNIQUE MEDICAL IMAGING 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	:	1194724542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUE MEDICAL IMAGING SC

Provider Business Mailing Address
First Line	:	920 MOUNT VERNON AVE
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2766
Country	:	US
Telephone Number	:	847-298-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 S WAUKEGAN RD
Second Line	:	SUITE 214
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2608
Country	:	US
Telephone Number	:	847-298-2192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEEPAK P DALIA
Credential	:	M.D.
Telephone Number	:	847-298-2192

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/01/2015

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