Provider Demographics
NPI:1801420823
Name:ALL-STAT PORTABLE WI, LLC
Entity type:Organization
Organization Name:ALL-STAT PORTABLE WI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-337-1199
Mailing Address - Street 1:8235 CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2910
Mailing Address - Country:US
Mailing Address - Phone:224-337-1000
Mailing Address - Fax:224-337-0100
Practice Address - Street 1:4811 S 76TH ST # 405
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:224-337-0073
Practice Address - Fax:224-337-0074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL-STAT PORTABLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-28
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier