Provider Demographics
NPI:1861648917
Name:MEDICAL DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-626-0800
Mailing Address - Street 1:3701 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4019
Mailing Address - Country:US
Mailing Address - Phone:847-626-0800
Mailing Address - Fax:847-626-0819
Practice Address - Street 1:4479 PONTIAC LAKE RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2059
Practice Address - Country:US
Practice Address - Phone:248-499-7618
Practice Address - Fax:248-499-7644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL DIAGNOSTIC SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-08
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00658473OtherRAILROAD MEDICARE PIN
MI0H01066OtherBLUE CROSS BLUE SHIELD PIN
MI0F38158OtherBCBS PIN
MIMI1727Medicare PIN