Provider Demographics
NPI:1205092350
Name:ILLIANA DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ILLIANA DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-612-3447
Mailing Address - Street 1:1347 LORRAINE PL
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6178
Mailing Address - Country:US
Mailing Address - Phone:708-952-4900
Mailing Address - Fax:708-952-4949
Practice Address - Street 1:3759 W 95TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERGREEN PK
Practice Address - State:IL
Practice Address - Zip Code:60805-2000
Practice Address - Country:US
Practice Address - Phone:708-952-4900
Practice Address - Fax:708-952-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile