MEDICARE: SKOKIE VALLEY RADIOLOGIST

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

General Provider Information

NPI Number	:	1205838828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKOKIE VALLEY RADIOLOGIST

Provider Business Mailing Address
First Line	:	9600 GROSS POINT RD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1214
Country	:	US
Telephone Number	:	847-933-6111
Fax Number	:	847-677-9625

Provider Business Practice Location Address
First Line	:	9600 GROSS POINT RD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1214
Country	:	US
Telephone Number	:	847-933-6111
Fax Number	:	847-677-9625

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEONARD BERLIN
Credential	:	M.D.
Telephone Number	:	847-933-6111

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2020

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