Provider Demographics
NPI:1104378942
Name:RADIOLOGY SUBSPECIALISTS OF NORTHERN ILLINOIS, LLC
Entity Type:Organization
Organization Name:RADIOLOGY SUBSPECIALISTS OF NORTHERN ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-928-5234
Mailing Address - Street 1:825 W STATE ST
Mailing Address - Street 2:SUITE 103E
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2080
Mailing Address - Country:US
Mailing Address - Phone:630-208-4412
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:SUITE 103E
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:630-208-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty