Provider Demographics
NPI:1235363755
Name:MIDWEST RADIOLOGIST, SC
Entity Type:Organization
Organization Name:MIDWEST RADIOLOGIST, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-236-8300
Mailing Address - Street 1:928 HOBSON RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8142
Mailing Address - Country:US
Mailing Address - Phone:630-236-8300
Mailing Address - Fax:630-236-9860
Practice Address - Street 1:928 HOBSON RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8142
Practice Address - Country:US
Practice Address - Phone:630-236-8300
Practice Address - Fax:630-236-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherSTATE LIC
ILL72461Medicare UPIN