Provider Demographics
NPI:1598720088
Name:INFINITE IMAGING INC
Entity Type:Organization
Organization Name:INFINITE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-928-6300
Mailing Address - Street 1:432 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5451
Mailing Address - Country:US
Mailing Address - Phone:773-925-6300
Mailing Address - Fax:773-928-5662
Practice Address - Street 1:1029 E 30TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60827
Practice Address - Country:US
Practice Address - Phone:773-928-6300
Practice Address - Fax:773-928-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054013996261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
IL210876Medicare ID - Type Unspecified
IL210891Medicare ID - Type Unspecified