Provider Demographics
NPI:1437231560
Name:FUTURE DIAGNOSTICS GROUP LLC
Entity Type:Organization
Organization Name:FUTURE DIAGNOSTICS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INVESTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THAKORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-725-1355
Mailing Address - Street 1:254 REPUBLIC AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6518
Mailing Address - Country:US
Mailing Address - Phone:815-730-3344
Mailing Address - Fax:815-730-3999
Practice Address - Street 1:254 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6518
Practice Address - Country:US
Practice Address - Phone:815-730-3344
Practice Address - Fax:815-730-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200825Medicare ID - Type UnspecifiedGROUP NUMBER