MEDICARE: QUALITY DIAGNOSTIC IMAGING,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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	9257193	IL

General Provider Information

NPI Number	:	1720038607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY DIAGNOSTIC IMAGING,LLC

Provider Business Mailing Address
First Line	:	2202 WEBER RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60435-0928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 WEBER RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60435-0928
Country	:	US
Telephone Number	:	773-297-6351
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SAMIUDDIN SYED KHAJA
Credential	:
Telephone Number	:	773-297-6351

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/21/2022

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