Provider Demographics
NPI:1710016290
Name:ENVISION DIAGNOSTICS INC
Entity Type:Organization
Organization Name:ENVISION DIAGNOSTICS INC
Other - Org Name:BATUTA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-494-0126
Mailing Address - Street 1:3000 DUNDEE RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2422
Mailing Address - Country:US
Mailing Address - Phone:224-235-4821
Mailing Address - Fax:847-383-6976
Practice Address - Street 1:3000 DUNDEE RD.
Practice Address - Street 2:SUITE 311
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:224-235-4821
Practice Address - Fax:847-383-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120986261QR0208X
IL036074107261QR0208X
IL036105010261QR0208X
IL036110490261QR0208X
IL036126885261QR0208X
IL036108313261QR0208X
IL036087491261QR0208X
IL036099445261QR0208X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL473809353310OtherHUMANA
IL1710016290Medicaid
IL2233357OtherBCBS
IL1710016290Medicaid