MEDICARE: BRIGHT LIGHT MEDICAL IMAGING, SC

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	:	1871527713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT LIGHT MEDICAL IMAGING, SC

Provider Business Mailing Address
First Line	:	31 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-1405
Country	:	US
Telephone Number	:	847-439-2315
Fax Number	:	847-439-3935

Provider Business Practice Location Address
First Line	:	31 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-1405
Country	:	US
Telephone Number	:	847-439-2315
Fax Number	:	847-439-3935

Authorized Official
Title or Position	:	OWNER
Name	:	RESHAM R MENDI
Credential	:	MD
Telephone Number	:	847-439-2315

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/30/2018

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