Provider Demographics
NPI:1083052757
Name:DAC IMAGING S C
Entity Type:Organization
Organization Name:DAC IMAGING S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHARLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-315-8046
Mailing Address - Street 1:4800 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1914
Mailing Address - Country:US
Mailing Address - Phone:312-315-8046
Mailing Address - Fax:312-284-4800
Practice Address - Street 1:4800 S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-1914
Practice Address - Country:US
Practice Address - Phone:312-315-8046
Practice Address - Fax:312-284-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360723292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty