Provider Demographics
NPI:1700051042
Name:GLOBAL MEDICAL DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:GLOBAL MEDICAL DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRWAJID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-673-0224
Mailing Address - Street 1:17W434 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3510
Mailing Address - Country:US
Mailing Address - Phone:630-673-0224
Mailing Address - Fax:630-622-1414
Practice Address - Street 1:17W434 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3510
Practice Address - Country:US
Practice Address - Phone:630-673-0224
Practice Address - Fax:630-622-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization