Provider Demographics
NPI:1902857881
Name:RANDALLWOOD RADIOLOGY ASSOCIATES, S. C.
Entity Type:Organization
Organization Name:RANDALLWOOD RADIOLOGY ASSOCIATES, S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-208-9325
Mailing Address - Street 1:1121 LAKE COOK ROAD
Mailing Address - Street 2:SUITE M
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5234
Mailing Address - Country:US
Mailing Address - Phone:847-945-4550
Mailing Address - Fax:847-948-8103
Practice Address - Street 1:1416C SOUTH RANDALL ROAD
Practice Address - Street 2:RANDALL SQUARE SHOPPING CENTER
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-208-9325
Practice Address - Fax:630-208-9326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532176OtherBCBS IL
IL04532176OtherBCBS IL