Provider Demographics
NPI:1780815241
Name:MEDRAD CLINICS, SC
Entity Type:Organization
Organization Name:MEDRAD CLINICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:UZOMA
Authorized Official - Last Name:EKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FACP
Authorized Official - Phone:630-967-4997
Mailing Address - Street 1:1225 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2407
Mailing Address - Country:US
Mailing Address - Phone:708-657-4540
Mailing Address - Fax:708-657-4535
Practice Address - Street 1:1225 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2407
Practice Address - Country:US
Practice Address - Phone:708-657-4540
Practice Address - Fax:708-657-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.617504261QH0100X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service