Provider Demographics
NPI:1487680765
Name:NORTHERN ILLINOIS IMAGING SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS IMAGING SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN-BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-758-8671
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-0665
Mailing Address - Country:US
Mailing Address - Phone:815-758-8671
Mailing Address - Fax:815-758-1731
Practice Address - Street 1:217 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3742
Practice Address - Country:US
Practice Address - Phone:815-758-8671
Practice Address - Fax:815-758-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206009Medicare ID - Type Unspecified