Provider Demographics
NPI:1396851713
Name:CONSULTANTS IN DIAGNOSTIC IMAGING SC
Entity Type:Organization
Organization Name:CONSULTANTS IN DIAGNOSTIC IMAGING SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRATHS-HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-756-1521
Mailing Address - Street 1:626 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4929
Mailing Address - Country:US
Mailing Address - Phone:815-756-1521
Mailing Address - Fax:
Practice Address - Street 1:626 BETHANY RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4929
Practice Address - Country:US
Practice Address - Phone:815-756-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209436Medicare ID - Type Unspecified