MEDICARE: RADIOLOGY REPORTS ONLINE, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1821226226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY REPORTS ONLINE, LLC

Provider Business Mailing Address
First Line	:	1440 S VILLA AVE
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-3405
Country	:	US
Telephone Number	:	630-650-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 W STATE ROUTE 22 STE 210
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2552
Country	:	US
Telephone Number	:	630-519-3485
Fax Number	:	630-230-8386

Authorized Official
Title or Position	:	CEO
Name	:	DR. AMJAD ALI SAFVI
Credential	:	MD
Telephone Number	:	630-519-3485

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	09/01/2020

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