Provider Demographics
NPI:1164761649
Name:MIDWEST MOBILE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MIDWEST MOBILE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:312-502-2286
Mailing Address - Street 1:175 N HARBOR DR
Mailing Address - Street 2:SUITE 2111
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7344
Mailing Address - Country:US
Mailing Address - Phone:312-502-2286
Mailing Address - Fax:
Practice Address - Street 1:175 N HARBOR DR
Practice Address - Street 2:SUITE 2111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7344
Practice Address - Country:US
Practice Address - Phone:312-502-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty