Provider Demographics
NPI:1306380951
Name:VILLAPARK MEDICAL IMAGING INC
Entity Type:Organization
Organization Name:VILLAPARK MEDICAL IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLAMATTATHIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-533-9029
Mailing Address - Street 1:646 N ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1419
Mailing Address - Country:US
Mailing Address - Phone:773-774-6430
Mailing Address - Fax:773-774-6405
Practice Address - Street 1:646 N ADDISON RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1419
Practice Address - Country:US
Practice Address - Phone:773-774-6430
Practice Address - Fax:773-774-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology