Provider Demographics
NPI:1902041502
Name:MDS DIGITAL PORTABLE X-RAY INC
Entity Type:Organization
Organization Name:MDS DIGITAL PORTABLE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
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 1:10300 W LINCOLN AVE
Practice Address - Street 2:SUITE. LL
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2100
Practice Address - Country:US
Practice Address - Phone:414-321-6666
Practice Address - Fax:414-321-6666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDS DIGITAL PORTABLE X-RAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI2691Medicare PIN