Provider Demographics
NPI:1740337476
Name:PRIMARY PHYSICIANS DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:PRIMARY PHYSICIANS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-831-5190
Mailing Address - Street 1:1806 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2303
Mailing Address - Country:US
Mailing Address - Phone:847-831-5190
Mailing Address - Fax:847-780-4503
Practice Address - Street 1:1806 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2303
Practice Address - Country:US
Practice Address - Phone:847-831-5190
Practice Address - Fax:847-780-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site