MEDICARE: SPECTRUM DIAGNOSTIC IMAGING 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
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1285875690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM DIAGNOSTIC IMAGING INC

Provider Business Mailing Address
First Line	:	3140 FINLEY RD STE B
Second Line	:	SUITE B
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1154
Country	:	US
Telephone Number	:	630-395-9233
Fax Number	:	630-395-9428

Provider Business Practice Location Address
First Line	:	3140 FINLEY RD STE B
Second Line	:	SUITE B
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1154
Country	:	US
Telephone Number	:	630-395-9233
Fax Number	:	630-395-9428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARAH SHAISTA
Credential	:
Telephone Number	:	630-362-6064

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	01/26/2012

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