Provider Demographics
NPI:1023575438
Name:IMG SOUND LLC
Entity type:Organization
Organization Name:IMG SOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-687-2241
Mailing Address - Street 1:2050 VALENCIA DR APT 214C
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7072
Mailing Address - Country:US
Mailing Address - Phone:847-687-2241
Mailing Address - Fax:224-326-2998
Practice Address - Street 1:1363 SHERMER RD STE 214
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4575
Practice Address - Country:US
Practice Address - Phone:847-687-2241
Practice Address - Fax:224-326-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty