Provider Demographics
NPI:1497971881
Name:UNIVERSAL RADIOLOGY LTD
Entity Type:Organization
Organization Name:UNIVERSAL RADIOLOGY LTD
Other - Org Name:UNIVERSAL RADIOLOGY LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-962-3900
Mailing Address - Street 1:2158 45TH ST. #519
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3742
Mailing Address - Country:US
Mailing Address - Phone:773-962-3900
Mailing Address - Fax:
Practice Address - Street 1:326 WEST 64TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621
Practice Address - Country:US
Practice Address - Phone:773-962-3900
Practice Address - Fax:773-602-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360393802085R0202X
IL0360652532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036039380Medicaid
IL036065253Medicaid
D12257Medicare UPIN
E19026Medicare UPIN
IL036065253Medicaid