MEDICARE: VALLEY IMAGING VT, 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1356522023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY IMAGING VT, LLC

Provider Business Mailing Address
First Line	:	903 COMMERCE DR
Second Line	:	STE. 333
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1969
Country	:	US
Telephone Number	:	630-928-5224
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 BOULDER HILL PASS
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1911
Country	:	US
Telephone Number	:	630-897-2848
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SYED AKBAR
Credential	:	MD
Telephone Number	:	630-978-4804

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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