Provider Demographics
NPI:1629364252
Name:EXCELLENT DIAGNOSTIC IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:EXCELLENT DIAGNOSTIC IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-364-1205
Mailing Address - Street 1:14489 JOHN HUMPHREY DR
Mailing Address - Street 2:SUITE 1-SC
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14489 JOHN HUMPHREY DR
Practice Address - Street 2:SUITE 1-SC
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2637
Practice Address - Country:US
Practice Address - Phone:708-364-1205
Practice Address - Fax:708-364-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty