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NPI Code Detail

MEDICARE: PROFESSIONAL DIAGNOSTIC SERVICES,INC

MEDICARE: PROFESSIONAL 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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1205081189
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL DIAGNOSTIC SERVICES,INC
Provider Business Mailing Address
First Line : 2200 W HIGGINS RD
Second Line : 215
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2428
Country : US
Telephone Number : 847-401-7475
Fax Number : 847-884-7133
Provider Business Practice Location Address
First Line : 9213 PARKLANE AVE STE 1
Second Line :
City : FRANKLIN PARK
State : IL
Zip : 60131-2837
Country : US
Telephone Number : 847-227-8780
Fax Number : 844-496-9345
Authorized Official
Title or Position : ADMINISTRATOR
Name : RICHARD FELICELDA
Credential :
Telephone Number : 847-802-2288
Provider Enumeration Date : 11/19/2008
Last Update Date : 03/18/2020

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Directions to “PROFESSIONAL DIAGNOSTIC SERVICES,INC ” Practice Location

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