Provider Demographics
NPI:1356599732
Name:CENTRAL DUPAGE IMAGING CENTER LLC
Entity type:Organization
Organization Name:CENTRAL DUPAGE IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUPLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-736-2991
Mailing Address - Street 1:2001 N GARY AVENUE
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-614-4260
Mailing Address - Fax:630-614-4275
Practice Address - Street 1:2001 N GARY AVENUE
Practice Address - Street 2:SUITE # 100
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-614-4260
Practice Address - Fax:630-614-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology