Provider Demographics
NPI:1134468655
Name:SHARP IMAGE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SHARP IMAGE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALOKWU
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:219-942-2300
Mailing Address - Street 1:111 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5990
Mailing Address - Country:US
Mailing Address - Phone:219-942-2300
Mailing Address - Fax:
Practice Address - Street 1:111 W 10TH ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5990
Practice Address - Country:US
Practice Address - Phone:219-942-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory