Provider Demographics
NPI:1760885750
Name:ONSITE DIAGNOSTICS, SC
Entity Type:Organization
Organization Name:ONSITE DIAGNOSTICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAATOUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-810-9095
Mailing Address - Street 1:5630 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1546
Mailing Address - Country:US
Mailing Address - Phone:847-810-9095
Mailing Address - Fax:
Practice Address - Street 1:5630 LYONS ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1546
Practice Address - Country:US
Practice Address - Phone:847-810-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty