Provider Demographics
NPI:1700100245
Name:ISLAND RADIOLOGY SC
Entity Type:Organization
Organization Name:ISLAND RADIOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUNST
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:847-559-9180
Mailing Address - Street 1:1901 RAYMOND DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6720
Mailing Address - Country:US
Mailing Address - Phone:847-559-9180
Mailing Address - Fax:847-464-8057
Practice Address - Street 1:1901 RAYMOND DR
Practice Address - Street 2:SUITE 19
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6720
Practice Address - Country:US
Practice Address - Phone:847-559-9180
Practice Address - Fax:847-464-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360862892085R0202X
IL2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3278Medicare PIN
ILDR2314Medicare PIN