Provider Demographics
NPI:1396924312
Name:NORTHERN ILLINOIS IMAGING SERVICES LTD
Entity type:Organization
Organization Name:NORTHERN ILLINOIS IMAGING SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMLATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-464-8896
Mailing Address - Street 1:2000 QUAILS ROOST DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2795
Mailing Address - Country:US
Mailing Address - Phone:815-806-2200
Mailing Address - Fax:
Practice Address - Street 1:2000 QUAILS ROOST DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2795
Practice Address - Country:US
Practice Address - Phone:815-806-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF72458Medicare UPIN