Provider Demographics
NPI:1922373497
Name:PRIMECARE DIAGNOSTICS INC
Entity Type:Organization
Organization Name:PRIMECARE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDARANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-452-6842
Mailing Address - Street 1:2801 W ESTES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2903
Mailing Address - Country:US
Mailing Address - Phone:708-452-6842
Mailing Address - Fax:
Practice Address - Street 1:2801 W ESTES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2903
Practice Address - Country:US
Practice Address - Phone:708-452-6842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherCOMMERCIAL INSURANCE